STPAN 14 24 SECOND ANNUAL REPORT ON THE SANITARY CONDITION or SAINT PANCRAS, MIDDLpiX^ DURING THE YEAR 1857, BY THOMAS HILLIER, M.D. Lorn., licentiate of the royal college of physicians, fellow of the royal medical and chirurgical society, vice·president of the north london medical society, honorary assistant physician to the hospital for sick children, medical officer of health. PRINTED BY ORDER OF THE VESTRY, London: henlly mitchenerj printer, xxvi, eversholt strjigt, oakley square. 1858. SECOND ANNUAL REPORT op the MEDICAL OFFICER OF HEALTH, TO THE VESTRY OF SAINT PANCRAS, Gentlemen, The time has now arrived that I should present to you my annual statement on the sanitary condition of your parish during the year 1857. In doing so I am glad to be able to congratulate you on having passed through another year without experiencing the invasion of any serious epidemic; also that your district has been less unhealthy than during ten preceding years taken together, and that its sanitary state will admit of favorable comparison with that of many adjoining districts. Whilst these points are matters for sincere congratulation, there is one aspect in which they afford grounds for serious caution. There is danger lest seasons such as those with which we have for two years been favoured should induce you to undervalue sanitary improvements, and to rest satisfied with the present state of things, entirely forgetting the experience obtained when cholera was raging in our midst, and the resolutions of reformation then formed. The history of the past will show that such has been uniformly the effect upon mankind of healthy periods. Sanitary reforms have always been the results of great pestilences; and so soon as the pestilence is forgotten, sanitary precautions are discontinued. It was so in the fourteenth century, when this country suffered from the invasion of that most fearful pestilence known as the Black Death. It was so three hundred years later, in 1636, when the plague again invaded this metropolis. The very same sanitary measures which had been adopted after the former pestilence, and had been subsequently discontinued, were now repeated; and within thirty years the improvements then advised, many of which were at the time carried out, had again to be enforced owing to another invasion of the plague. Two centuries later this country is visited with a new disease, the cholera-^ and this visitation has had the effect of inducing what has been lately characterised as a " sanitary mania." The term is certainly not inappropriate if the measures of precaution be only employed for two or three years, whilst the ravages of the epidemic are fresh in our memory. But if the history of past Sges, and the scientific discoveries of the present century be attentively considered, and, under the direction of these guides, precautions be constantly taken, 4 and improvements be steadily and from year to year persevered in, notwithstanding a moderately good state of public health, sanitary reform will prove to be the most valuable one that has ever been experienced by mankind. " In the great objects which sanitary science proposes to itself, in the immense amelioration which it proffers to the physical, to the social, and indirectly to the moral condition of an immense majority of our fellow creatures, it transcends the importance of all other sciences, and its beneficent operations seem most nearly to embody the spirit and to fulfil the intention of practical Christianity." STATISTICS OF THE TEAR. During the fifty-three weeks ending on the 3rd January, 1858, the number of deaths registered in this parish was 4,148, and the number of births 6,472. To arrive at the real mortality amongst people fairly belonging to the parish a number of corrections must be made. In the first place must be deducted deaths in the Strand Union Workhouse, also those deaths in University College and Royal Free Hospitals which were of persons recently coming out of other parishes; whilst must be added deaths of St. Pancras people in a number of hospitals, namely, the Middlesex, King's College, St. Mary's, Children's, Bartholomew's, and London Fever Hospital, as well as of lunatics chargeable to this parish dying in various lunatic asylums. To obtain the actual mortality, moreover, the deaths must not be taken as registered, in weeks, but according to the time of their occurrence. When all these corrections are made, the mortality of St. Pancras during the year 1857 becomes 3,887.* To determine the rate of mortality in the existing population it is necessary to estimate the population living in the middle of 1857. This may be done in two ways : one that adopted in my first monthly report, is to assume that the population has increased since 1851 in the same ratio as it did between 1841 and 1851, in which case the population last year was 195,500; the other method is to suppose that the rate of increase in the number of births gives the rate of increase of the population; in this case we get a population something below 190,000.† On either supposition the mortality per 1000 is not far from 20. On the first hypothesis, of every 10,000 living 199-3 died, whilst on the second 204*6 died. During the year 1856 the rate of mortality calculated on the same principles, was a little lower, namely, 19-6 per 1000, or 196 out of every 10,000 living. The rate of mortality in the whole metropolis during 1857 was 22'5 per 1000. In the northern division of the metropolis, which includes Marylebone, Hampstead, St. Pancras, Islington, and Hackney, the rate of mortality was 21*22 per 1000. In Holborn district the rate was 24 08 ; the Strand 24*4; in St. Martins-in-the-Fields 24'77; in St. Giles 28'66 per 1000 ; and in Islington * The number of deaths occurine from 1st January to 31st December in St. Pancras was 3790, exclusive of those deaths in the University College and Royal Free Hospitals, which were of nonparishioners. The number of those belonging to this Parish, who died in Institutions out of the Parish, so far as I have been able to ascertain them were:—35 in Middlesex Hospital, 15 in various Lunatic Asylums, 13 in King's College Hospital, 11 in St. Bartholomew's, 10 in the Hospital for sick chrildren, Great Ormond Street; 6 in the London Free Hospital, 5 in the Charing Cross Hospital, and 1 at the Forest Gate Schools. t The population is supposed to be increasing by about 5,000 per annum at the present time During last year the excess of births over deaths was 2324, and in addition to this increase, thera were probably more than as many other inhabitants added by immigration. 5 about 17.7. To sum up, tlie mortality of St. Pancras in 1857 was higher than that in 1856, lower than the average of ten preceding years, lower than that of the metropolis as a whole, and lower than that of the group of districts amongst which it stands. But we must not conclude from these facts that St. Pancras has been as healthy as it ought to be; far from it. We must not look for our standard to other places where precisely the same causes exist to shorten life as in this parish; but must find out, if possible, what is the natural mortality amongst Englishmen living in towns under favorable sanitary regulations. Unfortunately we can find no large body of Englishmen breathing pure air, taking pure food, and free from vice. In the words of the Registrar·General, " We can point to no model city—to no model caste. "We can discover no model parish in the country." It should be our ambition to constitute ourselves a model. We can, however, at present find districts in which the mortality of a town population is very much lower than in St. Pancras. The Registrar·General tells us that a mortality of 17 per 1000 is one which may very fairly be aimed at and expected even in large towns so soon as the laws of nature are not violated, and the teachings of sanitary science are fairly observed. That something has been done to prolong human life of late years may be seen from the fact, that in London during the sixteenth century the population lived only about 20 years on an average, instead of 37 years as now, and out of every thousand living 50 died every year, instead of 22 or 23. If the mortality of St. Pancras had been at the rate of 17 per 1000 during 1857, instead of 3848 persons dying, there would have been only 3200; in one year 648 lives would have been saved. It will be interesting to compare the mortality of the various sub·districts of this parish with each other. We shall see that some of the sub·districts exhibit a much higher rate of mortality than others; out of 10,000 persons living in each, there died in Regent'sPark 218, in Tottenham231,in Gray's Inn 215, in Somers Town 218, in Camden Town 186, and in Kentish Town 177, so that in Tottenham Court Road sub·district people died at the rate of 23 per 1000, in Kentish Town they died at the rate of less than 18 per 1000. This is a difference so extraordinary that I have been at some pains to see whether there are any circumstances of age or civil condition which will help to explain it. If in a place there be an undue proportion either of very young or very old persons, this alone will increase the number of deaths per thousand, without at all proving that the place is proportionally unhealthy. I have therefore calculated what proportion of the whole population of each sub·district was under five years of age, and what proportion was above sixty years when the last census was taken. The results obtained by the calculation are as follows:— Names of sub·districts. What proportion children under 5 years of age bore to the whole population in 1851. What proportion persons above 60 years of age bore to the whole population. Regent's Park 122 : 1000 58 : 1000 Tottenham 113 : 1000 60 : 1000 Gray's Inn 118 : 1000 57 : 1000 Somer's Town 134 : 1000 56 : 1000 Camden Town, without workhouse 131 : 1000 57 : 1000 Kentish Town 133 : 1000 52 : 1000 The whole parish 125 : 1000 60 : 1000 The table may be read thus: in Regent's Park sub·district, of every 1000 persons living in 1851, 122 were under 5 years, and 58 above 60 years of age; 6 In Tottenham sub·district of every 1000, 113 ·were under 5, and 60 above 60 years of age, and so on in the other sub·districts. It appears that Tottenham Court had the smallest proportion of young and the largest proportion of old people, whilst Kentish Town and Somers Town, which have an excess of young, have a small proportion of old ; and so with the other districts. Consequently there is nothing iu regard to age which will explain any serious difference in the rate of mortality, seeing that any increase dependent on an excess of infants would be counterbalanced by the small proportion of old persons, and vice vend. Neither is there anything in the occupations or civil conditions of the people inhabiting the several sub·districts, which can, to any great extent, account for it. No doubt the proportion of poor is greater in the southern parts of the parish than in the northern, and this circumstance necessarily occasions a slight difference in the mortality of the two portions, but is quite insufficient to account for the great difference which actually exists. One very great advantage possessed·by the people* in the north of the parish is a greater amount of breathing space, inasmuch as in Kentish Town sub·district there are only about 23 persons to an acre; whilst in Somers Town and Tottenham Court sub·districts there are nearly 200 persons to the same area. Another advantage possessed by the north of the parish, is its superior elevation, the average elevation of Kentish Town above high·water mark being 110 feet, whilst that of the entire parish is only 80, some part being only 50 feet above high water. Kentish Town has the advantage also of being on a declivity, which is very favorable to good drainage; and further has a smaller proportion of badly drained houses and houses with cesspools. It must not be supposed from this that the northern part of this parish has toothing to raise its mortality above what is unavoidable. The same circumstances which I mentioned in my last annual report still exist. The old Fleet Ditch and its tributaries in the Gospel Oak Fields are still uncovered, are monthly receiving additional drainage from newly built houses, and are now a most pestilential nuisance,—on which I have elsewhere specially reported. Torriano Avenue and part of Gloucester Place are still without a sewer, and the drainage from them finds its way into the fields between Camden Crescent and the Kentish Town Road. Very much may be done to reduce the mortality in the north of the parish, and still more in the south. The evils which accompany density of population may be very much diminished, by improved ventilation of streets and courts, and still more by Ventilation of the separate rooms occupied by whole families, by Ventilation of sewers and other improvements of drainage, and by the adoption of better plans for the disposal of household refuse. If it were possible to furnish you with statistics derived from smaller subdivisions of the parish, the differences in the rate of mortality would be more striking still; but inasmuch as at present I have no means of ascertaining, except in a few instances, the populations of such smaller divisions, I cannot state to you with accuracy what the differences are. In two streets, which may each be regarded as the specimen of a class, the population has been ascertained approximately by a house to house visitation, and the numbers are as under :— Deaths in Years Mortality per Names of Streets. No. of Houses. Population. 1856 and 1857. 1000 per annum Ashby Street 28 355 20 28 Henry Street 45 1100 46 24 Ashby Street is a street without a sewer, and consequently badly drained. Each house is let out in separate tenements to different families. Henry Street is also very crowded, but tolerably drained. On comparing the number of deaths during two years with the number of houses in some of the more unhealthy streets, I find that in some there have been more than as many deaths in the two years as there are houses ; in others four deaths for every five houses ; in others three for every four, and in others two for every three houses. These facts exhibit a very high mortality, even when allowance is made for the large numbers living in many of the houses, and the unhealthiness of many of these places is more striking when the diseases which prove fatal and the ages which death occurs are attentively considered.* The Tables which are appended to this Report have been drawn up with great care and at the expense of much labour. The materials which they comprise have been condensed as much as possible. In Table I. are given the causes of the deaths, and the numbers attributed to each cause, registered in the various sub·districts and the workhouse, during the year 1857. In Table II. are given the number of births, the total number of deaths, and the numbers of deaths occurring at various ages in the sub·districts, as well as several other numbers of interest. Table III. shows the mortality and temperature of each week, and the average of corresponding weeks in ten preceding years. The first quarter's mortality was 1112, which is 5.1 per cent, below the corrected average ; the second was 933, which is 9'6 below; the third was 965, which is 11.5 per cent, below; and the fourth was 1026, which is 5.9 per cent, below the several averages. Of the 52 weeks 38 had a mortality lower, and only 14 higher than usual. The average temperature of 40 weeks has been above the mean of corresponding weeks in ten preceding years; so that the average temperature of the year has been unusually high. From Table V. it appears that deaths from tubercular diseases bore the game proportion to the total number of deaths in St. Pancras as in the rest of London; and that in Somers Town and Tottenham Court sub·districts these diseases were disproportionately fatal, whilst in Camden Town they are much less fatal; in Kentish Town and Regent's Park rather less fatal than in London as a whole. I believe that the prevalence of these diseases is almost proportionate to the defective sanitary state of a district. From diarrhoea and cholera St. Pancras had a much smaller proportion of deaths to the gross mortality than the entire metropolis; whilst in Gray's Inn sub·district the proportion of deaths from those diseases was higher than the average. Table VI. gives the number of cases of disease which came under the treatment of the District Surgeons during the last year. It will be seen that the total number of cases is much less than in the previous year. This is in part due to a more searching inquiry being now made than formerly by the visiting agents into the circumstances of those who apply for medical relief. As compared with the year 1856, there have been of low fevers not so much as half the number, of diarrhoea a few more, of scarlet fever more, of small·pox a few more, of hooping cough less. During the year no fewer than 16 persons committed suicide, 5 newly·born children were proved to have been murdered, 22 children suffocated in bed, 16 children died from burns and scalds, 1 child was drowned in a pan. * When such comparisons are made it is found thct where a high rate of mortality is present, there is usually a preponderance of deaths among infants, and an undue proportion of deaths from tubercular an'1 zyniotir diseases. 8 Table IV. shows the number of deaths from six epidemic diseases during the years 1855, 1856, and 1857. It will be seen that deaths from Measles have been more numerous, from Scarlet Fever, from Hooping Cough, and from Diarrhoea slightly more, from Typhus much less, and from Small Pox rather less, numerous than in 1856. Although Small Pox prevailed very much in some of the most crowded parts of Somers Town and the Gray's Inn Districts, yet there were only 11 deaths during the year, and these were all unvaccinated. I believe the small mortality may without presumption be in great measure ascribed to house to house Visitations in the localities where it prevailed, and the distribution of circulars issued by the sanitary committee at my suggestion, urging on the inhabitants to have their children vaccinated and use other precautions. The mortality might be much more diminished were the Vaccination Act compulsory, as it was intended to be. There are several very serious defects in that Act; amongst others, there is no one whose prescribed duty it is to warn, and subsequently to enforce, the penalty against those who neglect vaccination; and there is little or no provision made for the good quality of the vaccination performed. SANITARY IMPROVEMENTS EFFECTED OR REQUIRED. The scavengering work throughout the parish has been done with very much greater efficiency than formerly, so that decaying vegetable and animal refuse is not allowed to lie about to pollute the atmosphere. This is a point of much importance to health especially in narrow and crowded streets. The sanitary state of parts of the parish has been much amended by the improvement of the roads, especially in the northern part, and in Agar Town, where many new ones have been constructed. On this subject, however, your surveyor will report in more detail. During the year I have reported at some length on the "Water Supply of the parish. I pointed out the advantages that would result from a constant supply instead of the present intermittent method, and drew attention to the very defective provision often made for the reception and storage of water, especially in the houses of the poor. I also mentioned the provisions of the Metropolis Water Act, which contemplate the attainment of a constant supply, and pointed out the method by which it may be secured. The subject is of very great importance, and will, I trust, not be overlooked by the owners and occupiers of houses. I have also reported on the Imperial Gas "Works, near King's Cross, so that I need not refer to these at present. The cow-houses throughout the parish have been fully reported on. Since the time when that report was made a very large number of these establishments have been much improved in reference to drainage, paving, ventilation, and general management. They are, however, still very far from what could be wished. Neither the Vestry, the Sanitary Committee, nor myself, have been disposed to put individuals to any great expense in improving old premises which have been long devoted to this business. Nor have they, had they felt disposed, any power to exact many improvements which would be of very great service to, and some of which arc urgently required by, the health of the public. SLAUGHTER HOUSES. These are in a much more satisfactory state than they were before the licensing system was introduced. They are now under constant supervision, and the fear of losing the license operates in a very wholesome manner to check 9 negligence as regards cleanliness and general management. A considerable number of the places licensed for this purpose are much too small, and in the midst of too dense a population, to be properly fitted for such a business; and it will depend on the butchers themselves -whether they 'will continue to be licensed, seeing that by great care on their part the business may be carried on almost -without nuisance, -whilst by negligence the premises -will inevitably become nuisances, and injurious to health, in which case the magistrates will certainly refuse the renewal of the license. At the last Michaelmas Sessions 107 licenses in all tvere granted; three that had been previously granted were withdrawn, and five new applications rejected. There are now no areas of dwelling-houses licensed for slaughtering; formerly these places were constantly used fof that purpose. On several occasions during the year, butchers slaughtering in unlicensed places have been prosecuted and fined. CONDITION OP PRIVATE HOUSES. During the year a very large number of houses have been brought into a much better sanitary state, under the supervision of myself and the inspectors. The following is a summary of the improvements recorded in the books of this department during the year ending Lady-Day, 1858. Number of houses inspected and specially reported, 1005. Drains newly constructed, 150; improved, 193; trapped, 547. Cesspools abolished, 238. Water-closets furnished with pan, trap, and water supply, 266; new ones erected, 8 ; old ones supplied with water, 51. Dust-bins constructed, 138; repaired, 91. Pavement of cellars or yards, newly constructed or rclaid, 118. General water supply provided, 10. Houses cleansed and lime-whited, 168 ; improved as regards ventilation, 34. In order to bring about these improvements 536 notices have been issued, having reference to 1005 places. Of the whole number of places under notice the works required have been completed in 946, and in 59 they are not yet done. It would have been easy to have brought a much larger number of houses under notice, as in some localities it is impossible to go a step without discovering evils which urgently require removal; but the principle on which I have acted has been Hot to look out for new evils, until those forced on my attention have been as far as possible remedied. In some instances the owners of property give a great deal of trouble, and require a preliminary and final notice, frequent verbal warnings, and a summons before a magistrate before they will perform the works required. But I must say that the majority exhibit a very reasonable readiness to comply with the requirements of the Sanitary Committee; and wherever the object could be attained without recourse to law it has been my wish to do so. During the year under review, summonses have been taken out under the Nuisances Removal and Police Acts in 81 instances. Of these 9 only have been lost, and those chiefly from disputed ownership. There is one respect in which the houses of the poor are lamentably defective, and to improve which not much has yet been done. I refer to the means of ventilation. Small rooms, occupied by whole families night and day, very often have but one small window (which does not open at the top, and is seldom opened 10 at all) and a fire-place, to act as ventilators. The consequence is, that the air in them becomes most offensive and unwholesome, being seldom renewed, and constantly being rendered impure by the exhalations from the lungs and skin of the inhabitants. In addition to this, the stair-cases, from which most of the air comes into the dwelling-rooms, are themselves filled with unwholesome air, from the constant passing to and fro of the inmates of some of the rooms, and in many cases they are shut in at top and at the back, so that very little fresh air can come into them to displace the foul air which accumulates. The consequence of this is, that the fathers and mothers become unhealthy, children grow up or die scrofulous, consumptive, ricketty, or anaemic ; whilst in some cases low fevers are produced, and other epidemic diseases rendered more virulent. We have lately seen that in our army, chiefly owing to the closeness of the barracks, soldiers are more unhealthy than other classes of the community at the same ages, and die, especially of consumption, twice as rapidly. But in the houses of many of the poor the rooms are more close than any of the barracks. In the latter 450 cubic feet of space is the minimum allowed by regulation to each individual; whereas in the former that is almost a maximum ; the minimum it is difficult to give ; in this parish it is certainly much below 200 cubic feet. Can anything be done to remedy these evils ? You cannot give the poor larger rooms in many cases, but by calling on the landlord to improve the ventilation, the rooms may be rendered much less unhealthy, and this you have power to enforce under the Nuisances Removal Act by the 29th section, which provides that " if the medical officer of health certify to the local authority that any house is so overcrowded as to be dangerous and prejudicial to the health of the inhabitants, and the inhabitants consist of more than one family, the local authority shall cause proceedings to be taken before the justices to abate such overcrowding, and the justices shall thereupon make such order as they think fit." Now, you are at liberty to offer this alternative to the person permitting such overcrowding: either that he improve the ventilation, and thus remedy the evil, or else that he abate the overcrowding, which you can enforce by an appeal to the magistrate. I am not quite certain what is the best and cheapest method of ventilating the rooms of the poor—the introduction of a valve (such as that invented by Dr. Arnott), or a syphon into the chimney, the use of perforated glass, or one of Moore's ventilators in the window, the introduction of a perforated brick, or a plate of perforated metal into the wall near the ceiling and near the floor are methods which may be adopted with advantage in different cases, and in every instance should be combined with good ventilation on the stair-cases. Although more than 500 houses have had their draiuage improved during the past year, there are still thousands of houses in the parish in which it requires improvement. There are a number of streets and courts the houses of which cannot be properly drained for want of main sewers. In my last annual report I enumerated some of these places, and I regret to add, that what was then said is still true, and that no new sewers have been made under your direction during the year. In some places the nuisances arising from the want of them are very great. I believe the reason that no new sewerage has been undertaken during the year is, that you consider that the law relating to this subject requires amendment, and entails too much of the expense on the whole parish, instead of the owners of adjoining property. I trust another year will not pass without some progress being made on this head. Amongst the influences operating injuriously to the health of this as well as all other parishes in London, must never be forgotten the social and moral condition of many of the poor. Their filthy, improvident, and intemperate habits in some instances render any improvements which it is within the province of your board to enforce almost useless; and the unwholesome state of many houses is due more to the neglect of the tenants than to any fault of the landlords. Such 11 cases are, however, by no means the rule, but only the exception ; and, thanks to the exertions of ragged schools, city missions, reformatories, public reading rooms, and other similar agencies are, I trust, yearly decreasing in number. Improvements in the outward conditions and in the moral state of the poor must go on hand in hand. In the language of Mr. Simon, late medical officer of health in the City, now medical officer to the General Board of Health, " In the midst of inevitable domestic filth who can wonder that personal cleanliness should be neglected ? In an atmosphere which forbids the breath to be drawn freely, which maintains habitual ill health, which depresses all the natural spring and buoyancy of life, who can wonder that frequent recourse should be had to stimulants, which, however pernicious in themselves, still for a moment dispel the malarious languor of the place, give temporary vigour to the brain, and cheer the flagging pulses of a poisoned circulation? Who can wonder that habits of improvidence and reck-' lessness should arise in a population which not only has much ignorance and prejudice amongst it, but is likewise often unacoustomed to consideration and kindness ? Who can wonder that the laws of society should at times be forgotten by those whom the eye of society habitually overlooks, and whom the heart of society often appears to discard ?" The duty of helping those who from poverty, ignorance, or vice cannot help themselves, is becoming distinctly recognised, and must be manfully undertaken by all who are not themselves in such a condition, before many of the evils under which the poor groan can be to any great extent removed. All who have made themselves acquainted with the condition of many of the poor in London will agree with me when I say that before their moral and religious state is likely to be remedied, their physical condition must be improved, and their homes made more comfortable; they will then be fitted to receive the instructions of the schoolmaster and the minister of religion. On you devolves, to a great extent, the solemn responsibility of carrying out the preparatory work. As auxiliaries in this work, the support and establishment of societies for improving the dwellings of the poor, of public baths and washing houses, of societies for providing places of recreation for the children of the poor (such as the Playgrounds' Society lately established), are very important, and might be effected either by the Board in its corporate capacity, or by the exertions of individual members. UNWHOLESOME FOOD. The chief things under this head which have been brought under my notice during the year are decaying animal and vegetable products. For instance, about 500 putrid rabbits have been seized by the Inspectors, chiefly from the street stalls, and in smaller quantities from shops. In the summer a large quantity of mackerel, lobsters, and crabs, in a decaying state, and, from time to time, rotten fruit and vegetables have also been seized. No diseased meat so bad as to warrant seizure has been of late discovered, and the Inspectors report that there is a better quality of aieat sold in the poorer districts now than 18 months ago. The sausage makers' shops have been frequently visited, and scarcely any meat palpably diseased has been found, though much of it has been " very poor and skinny." It is, however, totally impossible to discover many diseases of animals unless the whole carcase is seen; and the public will only be protected from the consumption of diseased animal food whon an efficient system of inspection is carried out of all animals immediately they are slaughtered. WORKHOUSE. The mortality during the year 1857 in this building amounted to 347; a few more than in 1850, but very much below the average of three preceding yeart, 12 which was 393. It must be remembered, in estimating the mortality of the workhouse, that the number of inmates is on the increase from year to year. In 1846 the average number was about 1100, in 1856 1409, and in 1857 it was 1454. When this is taken into consideration it will be seen that thereof mortality is diminished more than would appear from the actual number of deaths alone. The causes of death are stated in full in Table I., and the ages at which they occurred in Table II. It will be seen that measles was fatal to 20, consumption to 56 (nearly one-sixth of the whole number), old age to 56 (nearly one-third of the deaths from this cause in the whole parish). Sixty deaths occurred under the age of 5 years ; above the age of 60 there were 158 deaths, which is nearly one-half of the whole number. Since January, 1856, very great improvements have been made in the workhouse. Nearly all the evils complained of by Dr. Bence Jones in his report to the Poor-Law Commissioners at that time have been remedied. The removal of the children to Forest Gate has placed a very large and well constructed building at the disposal of the Directors, who have adapted it in a very excellent manner to the use of the sick. Large and convenient buildings have been erected for the casual poor and those whom it is thought desirable to keep apart from the other inmates. Baths are provided for the use of all admitted to these wards, and an apparatus to bake and to fumigate the clothes with sulphur for the destruction of vermin and the itch. Attached to them are sheds for oakum picking, and near are yards for stone breaking. New wards, with all conveniences, have been built for the male lunatics and lying in women. The late women's infirmary has been fitted up for female lunatics, and this, as well as many other wards, has been provided with good airing grounds. "Little Bethlem," so often complained of, has been pulled down. The kitchen and laundry have been removed from the body of the house, and commodious, newly constructed ones, now stand detached in the garden, so as not to occasion any annoyance or ill effects to the inmates. The washing machine, erected at considerable expense, is no doubt a great boon, inasmuch as it thoroughly cleanses the foul blankets and other heavy articles which formerly were never fairly purified ; and it also gets through so much more washing than could formerly be effected by the pauper washerwomen, and thus allows of a frequent change of body and bed-linen throughout the establishment. The result is that itch, which formerly existed almost throughout the building, is now a rarity. All underground sleeping-rooms are disused. The enlargement of the kitchen allows a great improvement in the cooking. There has been carried out, too, a very satisfactory classification of the inmates, who were formerly distributed over the building in a most miscellaneous manner. The men are now separated from the women, the sick from the healthy, the insane from the sane, the infants from the adults, the bedridden from the able-bodied. Each class has now its allotted portion of the building. The ventilation of many parts has been much improved. There have been many other things effected to improve the health of the inmates, besides those which I have enumerated; but it is unnecessary for me to dwell upon them, as they have been for the most part brought under your notice from time to time by reports from the Directors. The amount of space now allotted to the inmates is in all cases equal to, and in many exceeds, that which is usually allowed in workhouses according to the requirements of the Poor Law Board. In the City of London Union, Bow Road, which is very well conducted, and in many respects may be regarded as a model workhouse, the space allowed for adults, in rooms occupied day and night, is about 500 cubic feet; and in rooms occupied by night only about 400 cubic feet. This standard is rather lower than that which is fixed in your workhouse; the maximum number now 13 allowed being painted on the door of each ward. It is only in the depth of winter that this maximum will be reached; because at other seasons the number of inmates is so much smaller, that it is not necessary to fill the wards to that extent. In the sick wards the amount of space allowed is about 700 cubic feet. It is a mistake, however, to rely only on the amount of space, given to each inmate, because the sufficiency or non-sufficiency of that space for health depends entirely on the frequency with which the air in it is renewed; or, in other words, on the efficiency of the ventilation. The wards of your Workhouse are, for the most part, moderately ventilated ; but not, in all cases, so efficiently as to render the space allowed sufficient to supply each inmate with air of such purity as is requisite to insure the greatest degree of health. The ventilation in the body of the house might be much improved, by providing for a freer circulation of air in the main passages. This might be done by extending the iron gratings between the floors, and making more openings in the roof. Unless the air in the passages be kept pure, it is obvious that the inmates of one ward get—instead of fresh air to breathe—a great deal of what has been used in another ward, and the same air is breathed over and over again in different parts of the building. Individual wards, too, might some of them be improved in ventilation at a small cost. On comparing the state of the building now with its condition two years ago, no one can avoid seeing that wonderful progress has been made, probably quite as much as financial considerations have rendered admissible in the time. A little more improvement will make your Workhouse a model for the rest of the metropolis. At the present time improvements are advancing; the former girls' school building, to which I alluded two months ago, is now undergoing complete renovation, and is to be provided with water supply, water closets, and every convenience on each floor. EFFECTS OF OCCUPATION ON MORTALITY. This is an important sanitary question ; and, by determining the relative duration of life amongst persons following different daily pursuits, we shall be in a position to discover many causes operating to shorten life, and to point out remedies for some of them. For this reason I have taken the trouble to arrange in a table, which gives the occupations of the deceased, all the deaths occurring in St. Pancras above the age of 20 during 1856 and 1857. The results obtained by the analysis of two years' mortality are not, by themselves, of very much use; to draw any legitimate conclusions as to the effects of occupation upon life, two things are required; observations extended over a series of years, and accurate information as to the numbers living at different ages who follow the different occupations. Such information will not be obtained until the census of 1861. To show th8 necessity for knowing the numbers living at different ages, in order to render this enquiry profitable, it is only requisite to consider how very much larger proportion of persons die at advanced ages than between 25 and 40 years of age, and, also, how from the very nature of some occupations there is an excess of young persons who follow them, whilst from the nature of others there is an excess of old who belong to them. Some of the figures obtained by the analysis are, however, interesting. The following classes of occupation stand very high as regards their rate of mortality:—Hawkers, cabmen, actors and actresses, coal-heavers and chimney sweepers, cab-owners and livery stable keepers, soldiers, publicans, horse dealers and cattle salesmen, workers in copper, tin, and brass, stationers, greengrocers and corn merchants, civil engineers, porters and messengers, engine drivers and stokers, hatters and hosiers, tallow-chandlers and dealers in skins, navvies, tailors, and brush makers. 14 These are given in the order of their rate of mortality from above downwards ; the whole of them show a mortality above 20 per 1,000 (calculating from the numbers living at the census of 1851). The average rate of mortality amongst all classes was about 19 per 1,000, calculated in the same way. Hawkers, cabmen, and actors, exhibited a mortality more than twice the average ; and the other classes enumerated above gradually decreased from 38 per 1,000 down to 20 per 1,000. It would be interesting to speculate on the various causes which have raised the mortality amongst the various classes, but I believe that such speculations would be almost futile from the causes stated, as well as from the small numbers with which we have to deal, and these enquiries must be postponed until data are obtained from a longer series of years. METEOROLOGY. On this subject I make use of the information supplied by the RegistrarGeneral for Greenwich. The peculiar phenomena of the year are the high temperature (51°1, being 2° above the average of 17 years), and the slowness of the wind's movements. " The wind, instead of moving at the average rate of 110 miles, passed over London at the rate of 81 miles a day, during the 53 weeks." " The rain-fall at Greenwich was 21'4 inches ; being inches less than the average of 40 years. The mean daily range of the temperature was 17°, which is 1.30° more than the average of 16 years. I have the honour to remain, Gentlemen, Your obedient Servant, 51, Upper Gowrr Street. THOMAS HILLIER, May 14 th, 1858. TABLE I.—Deaths from different causes occurring in the various Sub·Districts of St Pancras, during the year 1857. Whole Parish. Regent's Park. Tottenham Court Road. Gray's Inn. Somers Town. Camden Town. ftcntish Town. Workhouse. | Whole Parish. Regent's Park. Tottenham Court Road. Gray's Inn. Somers Town. Camden Town. Kentish Town. Workhouse ALL CAUSES 5831 636 607 520 730 382 609 347 7 Teething 38 5 7 7 3 8 8 Specified causes 3809 632 607 519 719 378 608 346 Quinsey 4 3 .. 1 1 Zymotic diseases 839 147 136 123 184 72 136 41 Gstritis 1 .. .. .. .. .. 1 2 Diseases of uncertain or variable seat 182 37 15 20 33 21 35 21 Enteritis 10 1 1 .. 3 2 3 Peritonitis 13 5 2 3 1 2 3 Tubercular diseases . 647 103 107 88 128 58 98 65 Ascites 14 2 3 3 2 .. 2 2 4 Diseases of the Nervou System 421 64 70 59 59 48 83 38 Ulceration of Intestines 7 2 1 2 1 .. 1 Hernites 9 3 2 1 1 .. 1 1 5 Diseases of the Organf of Circulation 140 29 14 23 28 13 18 15 IIeus 16 2 2 .. 5 2 4 1 Intussusception 6 2 1 .. 1 .. 2 6 Diseases of the Respira tory Organs 703 120 115 98 136 76 99 59 Stricture of Intestinal Canal 1 .. 1 7 Diseases of the Digest ive Organs 198 36 28 24 41 20 36 13 Disease of Stomach, &c. 17 2 2 3 4 1 5 Disease of Pancreas 8 Diseases of the Urinary Organs 64 12 14 12 9 .. 6 11 Hepatitis 2 .. 1 1 Jaundice 13 3 1 1 5 .. 2 1 9 Diseases of the Organs of Generation 24 3 6 3 5 2 2 3 Disease of Liver 44 6 4 4 12 6 4 8 Disease of Spleen 3 .. .. 1 1 .. 1 10 Diseases of the Organs of Locomotion 15 1 5 2 1 2 3 1 8 Nephritis 5 2 .. 3 Nephria (Bright's Dis.) 35 7 8 4 6 .. .. 10 11 Diseases of the Integu mentary System 8 2 1 2 2 1 Ischuria 1 1 Diabetes 3 .. .. 1 .. .. 2 12 Malformation 9 1 1 .. 3 2 1 1 Stone 2 .. 1 1 13 Premature Birth and Debility 121 21 16 12 21 20 23 11 Cystitis 1 .. .. .. .. .. 1 Stricture of Urethra 2 .. 1 .. .. .. 1 14 Atrophy 99 15 15 18 16 10 l6 9 Disease of Kidneys, 15 Age 177 27 13 17 19 14 31 56 Bladder, &c. 15 2 4 3 3 2 1 17 External onuses 159 14 51 18 34 19 21 2 9 Paramenia 7 1 1 2 1 1 1 1 Small Pox 11 2 .. .. 9 Childbirth 15 3 5 2 3 1 .. 1 Measles 126 16 9 24 35 9 13 20 Diseaseof Organs of Scarlatina 99 22 11 6 28 11 21 n 04 14 14 3 Generation 2 1 1 Croup 35 8 6 7 3 4 7 10 Arthritis Thrush 14 3 • • 1 3 6 1 Rheumatism 5 .. 1 1 .. 1 2 Diarrhœa 159 29 25 30 33 10 30 2 Disease of Joints, &c 10 1 4 1 1 1 1 1 Dysentery 5 ... ... 2 1 1 1 11 Carbuncle 6 2 1 1 2 Cholera 9 ... 1 5 2 1 Phlegmon Influenza 7 1 ... ... ... ... 5 1 Disease of Skin, &c. 2 .. .. 1 .. 1 Scurvy and Purpura 1 .. .. 1 12 Cyanosis Ague 2 .. .. .. .. .. 2 Spina Bifida 2 .. .. .. 1 1 Remittent Fever 6 1 1 2 2 Othe Malformations 7 1 1 .. 2 1 1 1 Infantile Fever 9 .. 3 1 3 .. 2 17 Intemperance 7 1 1 7 3 1 Typhus Fever 122 18 17 12 32 9 32 2 Privation of Food 2 1 1 Puerperal Fever (Metria) 7 2 3 1 1 Want of Breast Milk 16 4 1 2 5 3 1 Rheumatic Fever 11 3 2 2 1 3 Neglect Erysipelas 30 5 5 3 5 2 2 8 Cold Syphilis 22 4 3 4 2 2 2 5 Poison 9 1 4 .. 1 1 2 Noma (Canker) 1 1 Burns and Scalds 19 6 6 2 1 3 1 2 Hydrophobia Hanging & Suffoeation 29 .. 9 3 6 5 6 Hæmorrhage 9 2 1 1 1 .. 4 Drowning 8 2 .. .. 1 4 1 Dropsy 39 4 2 5 8 10 7 3 Fractures & Contusions 43 1 18 5 10 4 5 Abscess 19 4 2 3 5 2 3 Wounds 12 3 5 .. 3 .. 1 Ulcer 3 1 1 1 Other Violence 14 2 7 .. 2 .. 2 1 Fistula 1 .. .. .. 1 Causes not specified 22 4 .. 1 11 4 1 1 Mortification 8 2 .. .. 2 2 l 1 Cancer 94 22 7 10 16 7 17 15 Details of some of the Violent Deaths. Regent's Park.—Two Children, newly born, murdered. Suicides.—One from window; one gunshot; one drowned. Poison.—One by Oil of Vitriol.—One Injury in state of Intoxication. Tottenham.—One buffer accident; two travelling on rail; Seven from falling houses. Five children burnt, and one scalded to death; two children poisoned by narcotic poison. Two Suicides, One by prussic acid the other by sulphuric acid. Seven children overlaid. Gray's Inn.—Suicide from a window. Six children burnt. Two overlaid. Somcrs Town.—One suicide from a window ; one by hanging; two cut throats. Two newly born murdered. Four overlaid. Oamden Town.— One child burnt. One suicide by hanging. Four children smothered. Four persons drowned. Kentish Town.—One child burnt; two scalded. One suicide by corrosive sublimate; one by hanging. Five children smothered in bed ; one newly born murdered. One child drowned in a pan. In all.—Sixteen suicides; sixteen children burnt; seven from falling of a house; fiye newly born murdered; twenty·two children stifled in bed; three by railway accidents; one ohild drowned in a pan. Gout 3 Scrofula 9 20 2 5 2 3 .. 1 .. 5 .. 2 3 3 2 1 Tabes Mesenterica 62 6 4 11 15 12 8 6 Phthisis (Consumption) 475 76 81 64 91 36 71 56 Hydrocephalus 90 16 19 12 17 8 16 2 4 Cephalites 53 7 7 4 11 8 14 2 Apoplexy 118 14 22 17 19 18 16 12 Paralysis 62 7 3 7 15 3 15 12 Delirium Tremens 6 1 .. 1 .. 1 1 2 Chorea Epilepsy 16 4 3 2 2 1 3 1 Tetanus Insanity 1 .. .. .. .. .. ... 1 Convulsions 118 23 2d 19 5 14 24 8 Disease of Brain, &c. 49 8 10 9 7 3 10 5 Pericarditis 6 .. 1 1 3 1 Aneurism 14 1 3 1 5 1 1 2 Disease of Heart, &c. 120 28 10 ?1 20 11 17 13 6 Laryngitis 24 4 .. 5 3 2 10 Bronchitis 406 59 77 63 74 40 42 51 Pleurisy 1 .. .. .. .. 1 Pneumonia 209 44 33 23 45 20 37 7 Asthma 32 5 1 5 8 8 4 1 Disease of Lungs, &c. 31 8 4 2 6 5 6 N.B.—In this Table are included deaths in the Middlesex, and London Fever Hospitals, of St. Pancras people ; whilst the deaths in the Strand Union are excluded, and also deaths in Hospitals of those who were known to have belonged to other districts; while tfther deaths inHospitals have been referred to the sub·districts from which cach person came, wherever this could be ascertained. Total Bbths. Total Deaths. Under One Year. 1· 2· 3· 4· Under Fire Years. 5· 10· 15· 25· 35· 45· 55· 65· 75· 85· 95 and above Proportion of Deaths under 5 years to Births. Estimated total mortality of cach Sub·District.* Number of Deaths to every 10,000 Living, t Number of Births to every 10,000 Living, t Proportion of Deaths under 5 to all Deaths. 114 636 152 65 36 22 15 280 17 12 32 44 45 33 62 57 41 13 .. 1:3.98 697 218 336 1:2.27 885 607 141 65 28 14 18 266 25 8 33 46 41 49 61 48 21 7 2 1:3.3 660 231 309 1:2.28 859 520 1 28 69 27 16 3 242 20 10 17 26 47 45 38 39 26 9 1 1:3.55 672 215 323 1: 214 1310 730 172 76 39 31 12 330 36 15 40 38 50 54 61 57 42 7 .. 1 : 3. 97 798 218 363 1: 2.21 690 382 116 37 22 9 7 191 14 6 23 18 28 27 26 24 20 6 .. 1:3.6 424 186 325 1:2 ']'P_{IMO <'']\' Pancras Workhouse 176 347 36 10 8 4 2 60 1 .. 16 28 30 41 43 70 37 20 1 1:3.0 .. .. .. 1:5.8 1293 609 170 67 23 14 19 283 25 9 32 40 38 34 51 42 45 9 1 1:4.57 680 177 336 1:2.12 6327 3831 915 369 183 109 76 1652 138 69 193 240 279 283 342 337 232 71 5 1 :3.83 3831 206 333 1 :2.32 Of every 1000 Born Of every 1000 Born the number that the number that died under 1 Year. died under 1 Year. Regent's Park 136 Camden Town 168 Tottenham 159 Worklionse 245 Gray's Inn 149 Kentish Town 131 Somers Town 131 * This number is obtained by taking the number of deaths registered in each Sub·District, and subtracting all the deaths in Hospitals, and allotting them to the several Sub·Districts from ·which the parties came to the Hospitals, omitting all the deaths in the Strand Union Workhouse, and distributing those in St. Pancras Workhouse over the Sub·Districts in proportion to their population. ·*■ These calculations are founded on the second method of estimating the population explained in the early part of my report. If the first estimate were taken, the number in these columns would be nearly 5 per cent, lower. Table III.—Table shewing the Mortality and Temperature of each week in the year 1857. and the average of corresponding weeks in ten preceding years. No. of week. No. of Deaths registered in each week Average of 10 Tears. Mean Temperature of week. Mean Temperature of corresponding week in 10 preceding Years. No of week. No. of Deaths, registered in each week. Average of 10 Years. Mean Temperature of week. Mean Temperature of corresponding week in 10 preceding Years. 1st +* 117 89·4 + DEGREES. 40·6 DEGREES. 38·4 r 27th. + 92 67·7 D + EGREES. G2·4 DEGREES. 60·7 2nd. — 82 82·1 + 36·8 33·3 28th. — 63 63·0 — 59·6 62·9 3rd. — 70 82·9 — 36·5 38·8 29th. — 50 69·0 + 68·0 62.6 4th. — 72 82·4 — 38·1 38·2 30th. — 79 74·2 + 68·3 62·2 5th. — 65 76·8 — 31·2 39·0 31st. + 95 72·4 + 656 62·4 6 th. + 95 79·8 — 32·3 41·0 32nd. — 74 83·6 + 63·7 62·0 7th. — 90 84·5 + 40·9 37·2 33rd. + 93 77·5 + 65·2 62·9 8th. — 92 88·8 + 42·5 39·7 34th. — 72 87·2 + 65·1 61·0 9th. — 78 74·9 + 41·2 400 35th. — 74 79·0 + 66·9 60·7 10th. + 85 73·3 + 43·1 39·3 36th. — 57 87·3 + 60·4 58·8 11th. + 91 818 — 37·2 41·0 37th. — 77 83·4 + 60·5 56·9 12th. — 81 86·3 + 45·1 41·3 38th. — 57 74·5 + 62·1 56·5 13th. + 95 82·3 — 39·6 42·0 39th. — 81 76·5 + 59·1 55·5 14th. — 81 79.9 + 47·8 45·3 40th — 65 73·2 + 58·4 53·8 15th. — 75 73·2 + 49·9 45·6 41st. — 59 65·9 — 50·7 50·8 16th. — 76 77·9 — 43·4 46·3 42nd. — 56 62·9 + 55·2 50·4 17th. — 73 74·5 + 46·6 45·9 43rd. — 68 69·6 + 51·5 50·1 18 th. 80 77·4 415 47·1 44th. __ 70 67·9 + 51·6 47·5 19th. + 88 69·3 — 44·8 48·9 45th. — 64 72·4 + 63·8 46·6 20th. — 70 750 + 57·6 51·9 46th. — 81 75·3 + 45·1 44·2 21st. — 67 71·2 + 58·9 55·5 47th. + 92 73·5 + 44·2 41·8 22nd. — 60 67·3 + 56·9 55·8 48th. + 96 75·3 + 41·6 40·3 23rd. — 58 69·5 + 60·6 56·5 49th. + 109 85·5 + 46·1 41·6 24th. — 52 60·6 — 56·0 56·8 50th. — 85 94·6 + 45·0 43·7 25th. — 67 64·2 + 60·3 57·9 61st. + 95 82·3 + 45·6 39.6 26th. + 89 78·4 + 67·3 60·2 52nd. 88 84·2 + 47·1 38·8 • The signs ·j· and — indicate that the Mortality and Temperature were respectively higher or lower than the average of the several corresponding weeks in ten preceding years. TABLE IV.—Deaths from Small Pox, Measles, Scarlet Fever, Hooping Cough, Diarrheea, and TyphuB, in the years 1857,1856, and 1855. Small Pox. Measles. Scarlet Fever. Hooping Cough. Diarrhoea and Cholera. Typhus. Sum of the Six Diseases.[//###] 1857 11 126 99 163 168 137 704 1856 18 89 95 152 141 172 667 1855 42 53 229 167 120 121 732 TABLE V.—Showing the number of Deaths in the Metropolis, and in St Pancras and its Sub·Districts, from the Tubercular Class of Diseases, from Diarrhoea, from Low Fevers, and a few other Diseases, and the per centage which these numbers bear to the Deaths from all causes. All Deaths in 1857. Number from Tubercular Diseases. Per centage of these to all Deaths. Diarrhoea and Cholera Deaths. Per centage of these to all Deaths. Typhus, Infantile, and Remittent Fevers. Per centage of these to all Deaths. Disease of· Respiratory Organs, including Consumption. Per centage of these to all Deaths. Number from Convulsions, Hydrocephalus, and Teething. Per centage of these to all Deaths. London 60160 10217 16·9 3360 5·68 2301 3·8 10890 18·1 4150 6·90 Saint Pancras 3831 647 16·9 168 4·38 137 3·6 703 18·3 246 6·42 Regent's Park 636 103 16·2 29 4·56 19 2·8 120 18·9 44 6'91 Tottenham . 607 107 17·6 26 4·28 21 3·4 115 18·9 51 8·40 Gray's Inn . 520 88 16·9 36 6·73 16 2·9 98 18·7 38 7·30 Somers Town 730 128 17·5 35 2·88 37 5·1 136 18·6 25 3·42 Camden Town 382 58 15·2 11 4·80 9 2·3 76 19·8 30 7·85 Kentish Town 609 98 16·1 30 4·92 34 6·6 99 16'2 48 7·88 Workhouse . 347 65 18·1 2 0·57 2 0·6 59 170 10 2·89 [TABLE VI.] St. Pancras, Middlesex.—Cases of Sickness under the care of the District Medical Officers during the Fifty-Three Weeks ending the 3rd of January, 1858. Districts. Names of Medical Officers. Total No. of Cases. Low Fevers. Diarrhoea. Dysentery. Influenza. Scarlet Fever. Small Pox. Erysipelas and Pyoemia. Puerperal Fever. Measles. Hooping Cough. Bronchitis, Pleurisy, and Pneumonia. Carbuncles and Boils. North-West Mr. Adams 1310 23 65 1 2 42 6 7 21 35 83 6 South-West Dr. WlLDBORE 1859 27 129 •• 3 28 11 12 •• 64 24 225 8 South-East Dr. Davis 1832 20 237 1 •• 22 34 14 1 68 14 195 11 Central Mr. SUTHERIN 1424 34 116 •• 7 7 17 9 •• 58 28 187 7 North Mr. Jeffkrys 1372 34 121 •• 35 18 7 13 •• 26 J7 102 8 Totals 7797 138 667 2 47 117 75 55 1 237 118 792 39 In the Workhouse, 40 weeks from 22nd 1 March to January 3rd 1634 11 257 •• 126 •• 1 34 •• 19 18 202 16 Deaths Registered in St. Pancras in the Years 1856 and 1857 above the age of 20, arranged according to the Occupations of the Deceased. MALES. NUMBER OF DEATHS. Numbers living at the census of 1851, above the age of 20. At all ages above 20. Between 20 and 40 Years of age. Between 40 and 60 Years of age. Between 60 and 80 Years of age. Above the age of 80 Years. I. 1, Engaged by Post Office 167 6 2 •• 4 •• 1 & 3, Custom House and other Government Officers 452 11 2 3 5 .. 2, Police and Parochial Officers 494 14 4 7 3 •• II. Army, Navy, and East India Company 625 45 14 16 9 6 III. 1, 2 & 3, Members of the learned Professions . 1385 49 10 19 17 3 4 & 5, Parish and Law Clerks 711 20 10 6 4 •• 6, Druggists and Surgical Instrument Makers 190 8 3 2 3 •• IV. 1, 3 & 4, Authors, Editors, Teachers, &c. 635 16 3 7 5 1 2, Artists and Architects 651 11 2 2 5 2 V. Relatives (occupations not stated) and Scholars 330 9 8 1 •• •• VI. 1, Inn and Lodging House Keepers 204 7 1 4 1 1 2, Domestic Servants of all descriptions . 1287 47 18 15 11 3 3, Hatters, Hosiers, Hairdressers, and Um· brella Makers 552 26 5 4 10 7 Tailors 1679 76 21 23 23 9 Shoemakers 1759 70 13 19 34 4 VII. House Proprietors, Merchants, Bankers, Brokers, Auctioneers, Commercial Clerks, and Shipowners 2264 67 22 19 24 2 Pawnbrokers and Shopkeepers (not other· wise defined) 179 13 3 4 6 •• Haw kers and Pedlars 61 13 7 2 3 1 VIII. 1, Engine Drivers and Stokers 144 7 4 3 •• •• Others engaged in Railway Traffic . 677 19 13 4 2 •• 2, Toll Collectors, Cab Owners, and Livery Stable Keepers 196 17 6 5 6 •• Cabmen, Coachmen, (not Domestic Ser· vants) and Post·boys 404 44 18 16 10 •• Carmen, Carters, & others on the Road . 982 25 9 11 4 1 Omnibus Owners, Conductors, & Drivers . 111 4 1 3 •• •• 3, Boatmen & others connected with Inland Navigation 43 1 •• 1 •• •• 4, Sailors and others connected with the Sea 105 5 2 2 •• 1 5, 6, Persons engaged in Storage, Porterage, and Messages 1051 52 17 21 14 •• XI. 1, Land·owners, Farmers, and Graziers . 190 8 1 1 6 •• Agricultural Labourers .... 78 6 2 3 1 •• 2, 3, Woodmen, Gardeners, and Nurserymen . 338 11 1 3 3 4 X. Horse and Cattle Dealers and Farriers 176 13 2 8 1 2 Grooms and others engaged about Animals 397 13 2 9 2 •• XI. 1, Dealers in Books, Printers, &c. . 967 37 11 11 12 3 2, Engaged at Theatres 50 4 3 1 •• •• 3, Musicians( not teachers) Musical Instrument Makers 1294 46 14 17 12 3 4, 5, 6, and 8, Engravers, Picture Dealers, & persons connected with Games 879 31 11 14 4 2 7, Civil Engineers and Draughtsmen 158 8 .. 4 3 1 9, Watch Makers & Philosophical Instrument Makers 239 6 2 1 3 .. 10, 11, Gunsmiths, Engine, and Tool Makers . 308 13 3 4 6 •• 12, 13, Coach Makers and Saddlers . 764 17 1 10 6 .. 14, 16, Ship·builders and Wheel·wrights. 254 2 •• .. 2 •• 15, Surveyors, Builders, Carpenters, Brick· layers, Slaters, Plasterers, Plumbers, & others engaged in House Building. 5762 226 64 93 59 10 16, Dyers and Manufacturers of Chemicals 147 4 •• 2 1 1 Deaths Registered in St. Pancras in the Years 1856 and 1857 above the age of 20, arranged according to the Occupations of the Deceased. MALES. NUMBER OF DEATHS. Numbers living ; at the census of 1851, above the age of 20. At all ages above 20. Between 20 and 40 Years of age. Between 40 and 60 Years of age. Between 60 and 80 Years of age. A'jove the age of 80 Years. XII. 1, Cowkeepera and Milksellera 258 9 3 2 4 •• Cheesemongers, Poulterers, & Fiahmongera 327 7 3 2 1 1 Butchers & others dealing in Animal Food 567 17 2 10 3 2 2, 3, Soap and Tallow Chandlers and others I dealing in Skins, Horns, &c., . J 255 12 2 5 5 •• 4, 5, Dealers in Feathers, Hair, Brushes, &c. 187 8 4 6 1 •• 6, Dealers in Wool and Silk 250 11 1 5 3 2 XIII. Greengrocers, Corn Merchants, & Millers . 386 23 7 10 5 1 Bakers and Confectioners 825 24 5 12 7 •• 1 2, Maltsters, Brewers, and Wine Merchanta . 392 8 5 1 1 Publicans and Licenaed Victuallera 368 26 6 10 10 •• Grocers, Tobacconists, and Sugar Refiners . 508 18 4 10 4 •• 3, Oilmen and French Polishers 442 12 6 4 2 •• 4, 5, 6, 7, Dealers & Workers in Wood & Cork 1622 39 9 10 18 2 8, 9, 10, 11, Coopers, Basket, and Rope Makers 254 30 5 10 14 1 12, Dealers in Flax, Lace, & Cotton Drapers . 564 19 4 6 8 1 13, Paper Makers, Stationers, and Japannera . 344 20 7 6 5 1 XIV. Coal Minera and Merchanta 117 4 2 1 1 Coalheavera and Chimney Sweepa . 192 14 6 6 2 •• Engaged at Gas Works 173 7 2 4 1 •• 2. Bricklayers, Stone & Marble Masons, & Sandmen 693 26 4 11 10 1 Road and Railway Labourers 257 12 5 2 5 • • 3, 4, Earthenware and Glass Manufacturers . 169 4 1 2 1 • • 5, 6, Water Providers 35 1 1 •• 8 7, 8, Jewellers, Silversmiths, and Gilders . 654 17 5 4 .. Persons engaged with Copper, Tin Zinc, Lead and Brasa 475 32 7 13 10 2 14, Smiths and others working in Iron, Steel, Locksmiths, &c 903 31 10 10 11 •• XV. 1, Labourers (branch undefined) 1910 94 29 31 30 4 2, Mechanics, Manufacturers, and Shopmen J (branch undefined) 103 6 2 1 3 •• Others of Indefinite Occupation 34 •• •• •• •• •• XVI. Gentlemen, Annuitants, Independent 717 125 5 32 68 20 XVII. Dependent on Relatives, Alms, Paupers, Prisoners, and Vagrants. 39 9 •• 2 6 1 Persons of no Stated Occupation or Condition 697 7 3 2 2 •• FEMALES Relatives 28548 1360 330 415 473 142 Schoolmistresses and Governesses 977 14 3 5 5 1 Lodging-house Keepers 350 7 1 • • 6 17 Domestic Servants, Nurses, and Charwomen . 10122 285 85 83 100 Milliners, Dress Makers, and Stay Makers 4191 108 45 26 31 6 Washerwomen and Laundresses 3106 84 16 21 36 H Shopkeepers 131 2 • • 1 1 ;; 19 6 • • 2 4 Artificial Flower Makers 242 7 1 1 5 •• Milksellers 115 2 1 • • 1 •• Butchers 196 1 1 • • • • •• Drapers and Lace Dealers 153 3 1 • • 2 • • Crossing Sweepers • • •• •• •• •• I 50 2 •• • • 2 •• Gold Burnishers 12 1 25 63 21 Gentlewomen 2601 124 25 Dependent on Relativea or Alms, Paupers 344 9 1 1 6 1 Of no Stated Occupation 870 13 3 5 5 •• N.B.- The Occupations are arranged in accordance with the Classification of the Registrar Generai, and to his Lists the numbers at the left hand side refer. ' SAINT PANGEAS, MIDDLESEX. REPORT ON THE WATER SUPPLY, by THOMAS HILLIER, M.D., Medical Officer of health for the parish of St. pancras. TO THE SANITARY COMMITTEE. Gentlemen, Amongst the various subjects on which it is my duty to report to you, there is one of which hitherto I have said but little. I refer to the Water supplied to the inhabitants of this parish. The influence on the health of the public of good water for drinking and of a copious supply for other domestic purposes, it is impossible to over estimate. The most striking illustrations of this influence were given during the cholera epidemics of 1848-49 and 1853-54. The subject has been well investigated and reported on by Dr. Snow, and by Mr. Simon in a report to the President of the Board of Health, published in 1856. On the Surrey side of the river Thames there are nine registration districts, in which cholera has been especially prevalent whenever it has made its appearance in London. During the epidemic of 1853-54, one part of the population of this extensive area were drinking water supplied by the Lambeth Company from the Thames at Ditton, and another part, water supplied by the Southwark and Vauxhall Company from the Thames at Battersea. About 24,854 houses derived their supply from the Lambeth Company, and 40,000 from the Southwark and Vauxhall. Amongst the 166,906 persons, supplied by the former Company, there occurred 611 cholera deaths, being at the rate of 37 to every 1,000 persons living, whilst amongst 268,171 persons drinking water supplied by the latter Company there occurred 3,476 deaths, being at the rate of 130 to every thousand. So that the population drinking the foul water from Battersea, suffered threeand-a-half times as much mortality as the population drinking the less impure water from Thames Ditton. The populations compared were living side by side in precisely the same conditions of soil, climate, and social position; the only exterior influences by which they were differently affected were the different qualities of the water severally supplied to them. The very fearful outbreak of cholera in the Golden Square district in 1854, has been clearly traced to the use of water from a well contaminated by the partial escape of the contents of a cesspool into it. During the present year a very remarkable instance of the effect of water, in exciting cholera when the epidemic influence is abroad, has been furnished at "West Ham, near Stratford. At this place there have been about 20 cases of cholera, all occurring in adjoining houses. The whole of these houses wero supplied with water from two shallow wells, which were sunk in a gravelly soil, within a few yards of a sewer, and not far removed from a large cesspool. There was no evidence that there was any direct communication between the drainage and the wells, but it appeared probable that from filtration alone the water was rendered impure. The amount of organic impurity was not greater than is found in some of the surface wells of this parish. Two specimens of the water were examined by Dr. Thomson; one was found to contain 53-2 grains of total impurity and 2'48 grains organic, and the other 56'16 grains total impurity and 4-4 grains organic per gallon. Nothing special was noticed on microscopic examination. 2 There can be no doubt that the water was the special thing which determined the occurrence of cholera in these cases ; for whilst there were about 20 cases, and 7 deaths amongst a population of about 100 persons living in the houses, there were scarcely any other cases heard of in the surrounding neighbourhood. Nearly the only other fatal case occurring about the same time was that of a youth living at Bromley, about two miles distant, and it was ascertained that he had drunk of the water of one of the wells only two days before his death. It is not to be supposed that the water by itself was sufficient to cause cholera, for there is no reason to believe that it was more foul at the time when the cases of cholera occurred than it had been for many months previously; and we must suppose that there was some epidemic influence abroad predisposing to cholera, and this influence falling upon persons drinking water rendered impure by drainage was sufficient to produce the disease. So that we must not conclude because a water does not produce in times of health any very obvious symptoms, that therefore it will be innocent in times when cholera is epidemic. Good water copiously supplied is equally important in times when epidemic disease is not rife, although the dire effects of foul water are not then so strikingly exhibited by an increased mortality. "What then is the quality of the water used by the people of St. Pancras ? The water is supplied mainly by the New River Company, partly by the "West Middlesex, and partly by the Hampstead Company. In addition to these main sources of supply, there are a few wells in different parts of the parish. There is a well in the "Workhouse garden for the inmates of that establishment; there are also public wells, in Clarendon Square, in Burton Crescent, in Grafton Street, and in Goodge Street; private wells in the grounds of University College, one belonging to the Colosseum, one to the North-Western Bail way, one to Pickford & Co., and one at the Zoological Gardens. There is also a shallow well in Fitzroy Market, the water of which is preferred by the inhabitants for drinking to that supplied by the "Water Company, although it is too hard for washing purposes, and contains an excessive amount both of inorganic and organic impurity, as may be seen in the table given subsequently. The districts supplied by the three "Water Companies are as follows :— The New Biver Company supplies that portion of the parish, south of Fig Lane and east of the Hampstead Road, including Somers Town, Bedford New Town, Gray's Inn Lane, and Agar Town. The Hampstead Company nominally supplies the greater portion of Kentish and Camden Towns, but in consequence of a failure in their well, they have been obliged to connect their mains with those of the New River and the "West Middlesex, as a supplementary supply. The "West Middlesex Company supplies a small part of the parish to the west of the North-Western Railway and Tottenham Court Road. THE NEW RIYER COMPANY. The sources of supply resorted to by this Company are the river Lea, Spitalbrook; small springs taken into the river in its course; also the water-shed of the Northhall district, and four deep wells sunk into the chalk in Middlesex and Hertfordshire; and the Chadwell Spring, near Ware. The Lea yields 1840 cubic feet per minute; the wells at Great Amwell yield 274; the well in Hampsteadroad from 50 to 70; the Chadwell Springs about 500 cubic feet per minute. Since 1850 great improvements have been effected by this Company, at an expense of £566,000. Many of the bends of the New River have been cut off and straightened. Filter beds have been constructed at Stoke Newington and the New River Head, Pentonville, together covering 9 acres of area. The filtering medium is 5 feet thick, consisting of sand and gravel, in layers, which increase in coarseness towards the bottom. At the present time a very important improvement is being effected, namely, the diversion of the sewerage of the town of Hertford, at a cost of nearly £10,000, from above the point in the river Lea at which the Company take their supply. Hitherto this sewerage has polluted the water used by this Company. The Claremont-square reservoir, capable of containing 3J million gallons, has been covered over. The reservoirs near the Brecknock Arms and the Hampstead-road are not covered, but the water from them is not supplied for drinking; the former is used in the New Cattle Market; 3 the latter for the Baths and Washhouses in George-street. The Company state that nearly all the water supplied by them is now filtered, and that very soon they shall filter the whole of it. There is one point in the arrangements of this Company still open to objection; it is this, that the pipe from the tank at the New ltiver ltead, which formerly supplied water to the district, is retained for the supply of water unfiltered as before, during periods of frost. The Company's engineer considers that means of supply, independent of the filter beds, should be maintained, because 6 or 7 inches of snow may, in heavy falls, pass through the water on to the surface of the sand, and obstruct the filtering action. The superintending inspectors, appointed by the Hoard of Health, say on this point, " From all the experience on this subject that has comc to our knowledge, we have reason to believe that there would be no possible danger of this, if the ordinary depth of water is kept on the filter beds, while it would certainly be more satisfactory that the means of supplying unfiltered water to the district should be removed." During the past six months, solid impurities (in one instance I saw a small fish) have been sent out by the New ltiver Company with their water, which could not have passed through the filter; but it is perhaps too soon to judge of the efficiency of the new arrangements; and besides the Company acknowledge that hitherto they have been obliged to supply some unfiltered water. The daily quantity of water supplied by this Company in this and other districts is 25 million gallons, whilst the number of tenements supplied is 95,083. This is at the rate of 262 gallons per house, but this includes the water used for public purposes, and the amount wasted, which are probably not less than one-third of the whole, leaving about 174 gallons per house, or about 18 gallons per person. HAMPSTEAD WATER COMPANY. The sources of supply used by this Company are springs at Hampstead and Ken Wood, and an artesian well at Hampstead. A new boring at Kentish-town, which has been continued to a depth of 1302 feet from the surface, after passing through the chalk, instead of reaching a water-bearing stratum, has pierced a layer which has much puzzled geologists, and is supposed to belong to the new red sandstone series. Since 1850, two filter beds have been constructed by this Company; they consist of pebbles, shingle, gravel, and sand, and are 3| feet deep. WEST MIDDLESEX COMPANY. Since July 1855 the water has been taken from the Thames at Hampton. It flows directly from the river to the engine well, passing through wire screens and sheet piling into a pipe 4 feet wide. It is then pumped to Barnes, where there are two subsiding reservoirs, large enough to contain six days' supply. Three filter beds, covering an area of an acre and-a-half, have been recently constructed; the filtering medium is 4½ feet deep, and consists of Thames sand, hoggin, and gravel. The quantity of water sent out daily is 6,895,368 gallons; the number of tenements supplied is 25,732. This gives about the same amount per house as that supplied by the New River Company. The arrangements of the works are open to an objection similar to the one made to those of the New River, namely, that a direct connexion is maintained between the subsiding reservoirs and the main, so that it is possible to send out water which has not been filtered. The alleged reason is that the Company may be prepared for any accident to the filter beds ; but as these are arranged in three distinct divisions the precautions would seem to be wholly unnecessary. The importance of taking away from the Water Companies the opportunity of sending out impure water is exemplified by a recent analysis of the water supplied by the Southwark Company in September last, made by Dr. R. D. Thomson, when the water was found to contain grains per gallon of impurity, and of this 5 6 grains were organic matter. This is as impure a water as that which was supplied to the inhabitants of London, when it was taken from the Thames at Vauxhall. During the previous month of August, and in the subsequent month of October, it exhibited only 17½ grains of impurity, shewing that the great impurity just 4 noted was due to some temporary cause. Had this existed at the height of a cholera epidemic, we may fairly conclude that it would have been attended with just as serious consequences, as the use of similar water is proved to have produced in 1854. The water obtained from the river at Hampton is no doubt purer than that formerly obtained from Barnes. But as the river above this point receives the drainage from Windsor, Eton, Reading, and other places, it is by no means free from objection, and will every year become more and more impure, unless the sewerage of these towns be differently disposed of. The number of houses in this parish without any water supply is very small; indeed I have not met with any cases of this defect, except such as were temporary, and due to arrears in the payment of water rates; several cases of this kind have been noticed in my monthly reports. The system of supplying courts, comprising several houses, by means of one stand-cock, to which water is turned on for about half-an-hour in the day, is, I am glad to say, going out of use, and only two cases of the kind have come to my knowledge in this parish. Water is supplied daily, except on Sundays, by the New River and West Middlesex Companies to all their tenants, and for the most part by the Hampstead Company. The figures given above as to the amount of water sent out, may give a very erroneous impression of the quantity supplied to each person in houses, when there are 5 or 6 families with from 40 to 60 persons. Such houses are usually furnished with a miserable wooden butt, capable of containing sometimes but a few gallons. Before giving an account of the qualities of water supplied by these three Companies, it may be well for me to make some general observations on waters used for drinking. In chemical language water is Baid to be pure when it contains nothing dissolved or suspended in it. The nearest approach to pure water supplied by nature is rain water. All spring and river waters contain saline matters obtained from the soil, varying in quality and quantity, according to the strata through which they pass, and some carbonic acid gas; they usually contain a small amount of organic matter, that is, matter derived from the animal or vegetable kingdom. Some of these ingredients, though they are called impurities, yet in small quantities are not objectionable in drinking water, and render the water more palatable. The "hardness" of water depends on the quantity of salts of lime and magnesia which it contains; it is measured by degrees, one degree meaning that there is a quantity of lime corresponding to one grain of chalk in every gallon of water. By permanent hardness is intended that which is not removed by boiling, whilst temporary hardness is the amount that is got rid of by boiling; in the results given subsequently five minutes' boiling was used. The hardness of water used for washing causes a large consumption of soap, it also much increases the labour of washing, and the wear of the articles washed. Each degree of hardness requires a consumption of about two ounces to a hundred gallons of water; so that one hundred gallons of water, of 15 degrees of hardness, require about two pounds of soap more than would be needed by rain water, or water free from the salts of lime and magnesia. This may be regarded by some as of little moment in a sanitary aspect, but in my opinion anything which discourages and renders more expensive the thorough and frequent washing of clothes among the poor has a very important influence upon the spread of disease. Hard water, again, is much less fit for tea making, for cooking, and for brewing. To weakly persons, and those subject to some forms of dyspepsia, hard water is decidedly less wholesome than soft. The hardness of the water supplied by the Companies to this parish can be much reduced by boiling for a quarter of an hour, and this property may be taken advantage of in washing and cooking. Another method of reducing the hardness of such water as these is to employ lime water, as recommended by Dr. Clarke and practised by the Plumpstead and Woolwich Water Company. One advantage of this last method is, that it removes a largo quantity of organic matter, together with the carbonate of lime. The amount of organic matter in a water is frequently taken as an indication of its fitness or unfitness for internal use. This test requires some qualification. 5 We cannot hope to get water absolutely free from this impurity, and we have good evidence that water may contain a small quantity of some kinds of organic matter without any bad effects. It is the condition rather than the quantity of this impurity which decides its salubrity. Organic matter, derived from animal excreta, such as now find their way into the Thames, and other organic matters, which are undergoing decomposition, render water especially injurious. There is always a risk of such contamination in shallow wells, in large towns, which are therefore in my opinion much to be deprecated, and ought not to be allowed for drinking purposes. By chemistry it is very difficult to do much more than determine the amount of organic matter, and even this determination requires some of its most delicate processes. In support of the statement that the quantity of organic matter in water is not alone an exact measure of its noxious properties may be mentioned the fact that the Government Commission of 1851, found in the Battersea water, supplied by the Southwark and Vauxhall Company, the use of which so much increased the fatality of cholera, less organic matter than was found in the waters from Thames Ditton, which was so much less injurious. If, however, a water contain above a grain of organic matter, especially if it also contain nitrates or ammonia, these constituents though not in themselves necessarily injurious, should yet excite suspicion, and lead to a careful investigation of all possible sources of contamination to which the water is liable. They may be taken as evidence that the water has traversed a soil more or less impregnated with organic refuse, and there is always a risk that the organic matters may either, in some stage of their decomposition, or from a difference in their origin, or from some predisposing epidemic influence, acquire noxious properties which at present they do not possess. The most important lesson taught by the experience, gained on the subject of drinking waters in towns, is to remove them from every possible risk of contamination by animal excreta, such as arises from sewerage running into rivers, or from cesspools and drains communicating with shallow wells. The presence of microscopic animals and vegetables in water is an indication of organic impurity in a state of change. Their germs are at all times floating in the atmosphere, and their development is much promoted by light, air, and warmth. Their formation is checked by the use of water receptacles, which are securely protected from light and air by well fitting lids. At the end of this report are given the results of analysis of waters supplied by the three companies. It will be seen that the amount of organic matter which they contained in 1856 was much less than that given in 1851; and they also contain considerably less organic life. The amount of inorganic matter has undergone but little change; their hardness is about the same. The water, as available to the majority of the inhabitants of the parish, is, however, very far more impure than the water as sent out by the Companies. Its extra impurities are due to the mode of supply and the defects of storage. The ordinary receptacle for water in the poorer houses is a wooden butt, frequently uncovered; it is often much decayed, and lined with filth and organic growths. Its situation is usually near a foul privy or decaying dust heap, or in a damp cellar; the water thus becomes saturated with dust, dirt, and noxious gases. Water has a very remarkable power of absorbing and holding in solution gases which come near it, such as ammonia, sulphuretted hydrogen, which are the results of decomposition, and frequently carry with them animal and vegetable substances in a high state of putresence. In many cases the water-butt is not furnished with a tap, so that the water is taken out of it by any stray vessel, on which hands are laid. Another effect of such storage as this is the high temperature to which in summer the water reaches, which very much deprives it of all its thirst-quenching qualities, and very much increases its other defects. In some places there are underground tanks to supply a pump for the use of a number of houses. These tanks are objectionable from the risk of contamination, and from the difficulty with which they are cleansed. The additional labour entailed in obtaining water by this mode of supply is sufficient very much to diminish the amount of it used by many who are not very fond of its use. Within a very recent period, two of these cisterns have come under my notice in 6 consequence of the foul condition of the water in them; they had not been cleaned out for years; in one of them the water was actually putrid. There can be no doubt that the impurity, warmth, and want of freshness in the water supplied to the poor in London, tends very much to promote the excessive use of alcoholic drinks, which is one of the most fertile sources of disease, and originates every kind of social evil (the generally uncomfortable state of the dwellings of the poor operates in the same way). Even where the water-receptacle is well made and well placed, it remains so long without being cleared out, that it becomes very foul. Very commonly, even in the middle class of houses, the cistern for drinking water is directly connected with the water-closet, and sometimes, if proper precautions have not been taken, the effluvia from the closet pass back into the cistern, and render the water most impure. Most of the evils above-mentioned are inseparable from an intermittent mode of supply, and would be remedied almost entirely by a constant supply of water laid on at a pressure, just as gas. "Water might then be always at hand, it would be cooler and purer. The actual quantity of water required would probably not be increased, but it would always be present when wanted. The advantages of such a supply in cases of fire would be very great, because plugs might be so attached to the mains, that a jet would be within reach of every house, and would be more effectual than any fire engine. These jets would also be of great service for the purpose of street cleansing. The value of water in quenching a fire diminishes in a very rapidly increasing ratio with the time which elapses before water arrives.* A constant supply of the kind mentioned has been obtained in New York, Nottingham, Newcastle, "Wolverhampton, and other places, and has been found to answer well. It would no doubt be much easier to make arrangements for such a supply in a place where there had previously been no other mode adopted, than to adopt the old apparatus of an intermittent supply to the constant method, but the difficulties in the latter case are not insurmountable, and would in my opinion be amply repaid by the advantages following the change. The Metropolis "Water Act of 1852 contains a clause (sect. 15) to which I wish to call your attention:—"After the expiration of five years from the passing of this Act, every Company shall, subject to the provisions of the special Act relating to such Company, provide and keep, in tho district mains already laid down, or hereafter to be laid by them, a constant supply of pure and wholesome water, sufficient for the domestic use of the inhabitants of all houses supplied by such Company, at such pressure as will make the water reach the top story of the highest of such houses, but not exceeding the level prescribed by the special Act of such Company. Provided that no Company shall be bound to provide a constant supply of water to any district main until four-fifths of the owners or occupiers of the houses on such main shall, by writing under their hands, have required such Company to provide such supply, nor even upon such requisition, in case it can be shown by any Company objecting to the same, that more than one-fifth of the houses on such main are not supplied with pipes, cocks, cisterns, machinery, and arrangements of all kinds, for the reception and distribution of water, constructed according to the regulations prescribed by the special Act, or by this Act, or which any Company, with the approval of the Board of Trade, may from time to time make in that behalf; and after any such requisition as aforesaid shall have been delivered to the Company, it shall be lawful for the surveyor, or any other person acting under the authority of the Company, between the hours of 9 a.m. and 4 p.m., to enter into any house or houses on such district main, in order to ascertain whether the pipes, cocks, cisterns, and machinery of such house and houses are so constructed as aforesaid; and provided also that any Company may, with the consent of the Board of Trade, suspend the giving of such constant supply, or give the same in succession to the several districts of such Company, or to any parts of such districts as may be found to be convenient; and provided that it shall be lawful for the Company after due notice to abstain from supplying or to cut off the * These points are well brought out in a report to the General Board of Health on the supply of water to the metropolis, published in 1850. 7 communication if the pipes, cocks, cisterns, machinery, or arrangements, as aforesaid, shall not be in conformity with such regulations." This section appears to me of very great importance,—the time alluded to in the Act has now arrived. I trust that owners of property will be sufficiently alive to the value of a constant supply to exert themselves, and be willing to incur some expense in order to obtain it; and that Water Companies will not place obstacles in the way of carrying out the intentions of this clause. chemical characters op some of the well waters ik the parish. The Workhouse Well gives a remarkably soft water. It contains a large quantity of saline ingredients, chiefly alkaline, not earthy; the chlorides and sulphates predominate. It contains rather a large quantity of oxide of iron. On the whole, it is a very fair water for drinking; and is especially suited for washing and cooking. From the large quantity of alkaline sulphates which it contains, it probably acts on some persons as a laxative. The water comes either from the Thanet Sands or the upper layers of chalk. The well in Clarendon Square gives a water in many respects like that supplied by the Workhouse well; the water comes from the same strata. A pump in Eitzroy Market supplies an unusually hard water (42° of hardness); with more than 250 grains of total impurity, and a very large amount of organic matter. It contains also a notable quantity of nitric acid and ammonia. It is a water which, in my opinion, ought not to be used for drinking. The waters from shallow wells in Goodge Street, John Street, and Grafton Street are soft, they contain a very large amount of organic and inorganic impurities, and traces of ammonia. These wells are very liable to contamination, by communication with drains, gas pipes, and by the filtration of water through a porous stratum, saturated with various kinds of organic residue. Those waters ought not to be used for drinking. In the table below are given some results of analysis of some of the abovenamed waters, performed by different observers at different times. The results of analysis vary considerably according to the weather and the season of the year at which the water is obtained; to form a correct notion of the average quality of the water supplied, it should be analyzed very frequently, and at all seasons, after all kinds of weather. MICROSCOPICAL EXAMINATION OF WATER. New River.—The water from this Company I have examined on several occasions. Sometimes it has been almost entirely free from distinct animal or vegetable formations. At others I have found in it polygastric animalcules (oxytrichse and paramaecia), the shell of an entomostracous animal, apparently bosminia lagustris, some desmidia; and confervee. West Middlesex water I have found to contain a few animalculæ, but to be freer from organic formations than that of the New River Company. The Hanvpstead Water has varied very much, sometimes presenting little organic life; at others, I have found a specimen of anguinula fluviatilis, monads, paramæcia, fungi, and the synedra ulna. In the Workhouse well water and Fitzroy Market hard pump water I could detect no organic life. The quantity of nitrates in the latter water would prevent the growth of animalculæ, so that the absence of animalculæ may, in some cases, be an effect of impurity instead of a sign of purity. Dr. Hassall, in January last, reported to the President of the Board of Health, the results of examinations which he had been making of the water supply of the various Companies. His conclusions I may give so far as they concern the Companies which supply this parish. "The waters supplied by all the Companies still contain numerous living vegetable and animal productions, especially annelidæ, entomostracia, infusoriæ, confervæ; desmideæ, diatomacea, and fungi. That they were particularly abundant amongst others in the water supplied by the New River and Hampstead 8 Companies. That they were less abundant in the West Middlesex Company's water. The waters which contained most organic productions were cloudy and opalescent when seen in large quantities, whilst the others were clear and bright. Great improvement is doubtless manifest in the condition of the present supplies It should be recollected, however, that these examinations were conducted in Winter, at the period most unfavorable to the development of animal and vegetable life." Degrees of Hardness. Grains of solid matter in a gallon. Total. 'ermanent. Total. Organic. Water from New River Company. Examined in 1851 by Govern- ment Commission 14.9 . . . 19.50 2.79 The same examined in 1856, by Dr. Hofmann 14.6 7.75 22.36 0.910 12.6 9.25 21.07 1.015 13.1 6-5 21.91 0.98 The same examined by myself in Winter of 1856-7 12.6 11.5 20.46 0.56 West Middlesex Company Water examined in 1851 14.6 ... 22.67 2.75 The same examined in 1856 13.65 9.4 21.16 0.819 14.4 7.4 19.897 1.005 14.8 7.55 22.05 1.05 The same examined by myself in 1857 13.9 . . . 26.18 0.638 Hampstead Company's Water examined in 1851 9.8 ... 35.41 1.81 In 1856, the same examined by Dr. Hofmann 10.5 10.5 34.26 1.29 5.45 5.40 30.765 1.45 4.7 3.9 57.101 2.24 6.35 6.35 22.54 1.575 The same examined by myself as supplied to 95, Great College Street, in November, 1856 24.1 2.3 ... ... Ditto supplied to Carlton Road Villas 12.5 11.0 22.82 0.5 These specimens examined by myself in 1857. Water from Workhouse Well 3.5 . . . 47.21 0.49 Clarendon Square Well Water . 4.2 3.7 45.27 0.42 Fitzroy Market Well 42.6 41.0 275.4 3.64 Well on the grounds of University College 14.8 ... 13115 0.40 Pump water from Grafton Street . 3.7 . . . 141.82 2632 Pump water from Goodge Street . 5.2 . . . 264.32 16.7 9 SOIL OF THE PARISH. Four-fifths of the area of the Parish of St. Pancras is situated on stiff London clay, lying immediately beneath the made ground, which extends to the depth of a few feet only. At Highgate a little silicious sand, of the Bagshot series, comes to the surface; and in the country around, the clay is of a more loamy character than in the more southerly portions of the parish. Clay is a soil which is by no means the best fitted for human dwellings; it retains moisture for a long time, and does not readily allow drainage to soak into it; there is almost constant evaporation from it; and houses built on it are liable to be damp. Where houses are placed on such a soil, it is of the utmost importance that their foundations should be so made as to be secured from damp. This point has been very much disregarded in the northern parts of this parish, where houses have been of late years very rapidly springing up, and are, many of them, extremely damp. In these parts, too, water lies stagnant in fields, which are not yet built upon, and some of which are used for brick-fields. Several medical men, whose practice lies in this neighbourhood, have told me that they believe these parts in the undrained fields are very prolific sources of diseases. In the south-west of the parish there is a stratum of gravel and sand above the clay; it varies in depth from about 8 to 12 feet. This layer extends over that part which is south of the New Road and west of Upper Woburn Place, corresponding almost to the Tottenham Court Registration Sub-district. It also extends eastwards over a triangular piece of the Grays Inn Sub-district, the apex of the triangle is near Judd Street, and the base forms part of the southern boundary of the parish, adjoining the Parish of St. George the Martyr, Holborn, and reaching about half way towards the Grays Inn Road. North of the New Road the gravel also reaches for about 400 yards up Albany Street, and from this point the limit of it slopes down until it reaches the New Road, between Judd Street and Upper "Woburn Place. Depth of some of the wells in the parish of St. Pancras:— Feet. * Hampstead Water Works 1,300 Orphan Working School, Haverstock Hill 355 in the chalk. North-Western Railway 400 ditto. Pickford and Company 297 ditto. Zoological Gardens 274 ditto. Grimble and Company 307 ditto. Colosseum 250 ditto. Miller and Company 270 ditto. New River Company, Hampstead Road 238 ditto. Well on the Grounds of University College, ) 100 said to be in the Chalk Workhouse Well 260 into chalk or sands just above it. Well in Clarendon Square 138 believed to be chalk. Well in Grafton Street shallow, in the gravel above the clay Well in Goodge Street shallow ditto. Well in Fitzroy market probably shallow * For many of these I am indebted to Mr. Mylne, "sections of the Lndon strata;" for that in Clarendon Square to the kindness of Mr. Scott, the Chief Surveyor of the parish. 10 It may be interesting to give the thickness of the various strata passed through in the boring at Kentish Town by the Hampstead Water Company, as obtained from the Report to the President of the Board of Health above mentioned. Feet. 1. London clay 236 2. Sands 88½ 3. Chalk and chalk-marl 586 4. Marl, and sand of the Upper Greensand series 72 5. Gault 130½ 6. Red and yellow sands, red clay, white and red sandstone, greenish sandstone, &c. &c 188½ The chalk seldom comes nearer the surface in this parish than about 200 feet; and there is no water fit for drinking to be procured without passing through the clay (which is from about 150 to 250 feet in depth) to the chalk or to the sands immediately above this stratum. I have the honour to remain, Gentlemen, Your obedient Servant, THOMAS HILLIER. 21, Upper Gower Street, November 3rd, 1857. REPORT on the SANITARY CONDITION OF SAINT PANCRAS, MIDDLESEX, DURING DECEMBER, 1856, by THOMAS HILLIER, M.P., Medical Officer of Health for the Parish of Saint Pancras. January 2nd, 1857. No. 9. TO THE SANITARY COMMITTEE. Gentlemen— The number of deaths registered during the four weeks, ending December 27th, was 324. Eleven of the deaths in Hospitals were of persons recently come from other Parishes, so that they should not be reckoned, reducing the number to 313. The average mortality of the corresponding month in the ten immediately preceding years has been 347, which, when raised for increase of population, give 382, above 20 per cent. more than the present return. There has been a very small amount of fatal epidemic diseases. Hooping cough is, however, on the increase (7 cases last week); there has been no death from small pox; only 4 from scarlet fever; and 10 deaths from continued fever. Pulmonary complaints have been fatal to 80 persons, exclusive of 50 from consumption, and others from croup and hooping cough. Cerebral diseases have been fatal to 26, and heart diseases to 15 persons; syphilitic disease has been fatal to no less than 5 children. The mean temperature of the four weeks has been 40°.3, which is about above the average of corresponding months in previous years, and ½° lower than last month. The lowest temperature was on the 30th November, when the thermometer stood at 19°.4; the highest was on the 6th December, when 2 it was 58°.9. The mean temperature of the week, ending December 13th, was 10 above the average, and the mortality of the week following was one-third below the average. At this season of the year nothing has so much influence on mortality as the temperature. The following table shows the number of deaths from epidemic diseases, and from all other causes in the six sub-districts of St. Pancras, and in the two Workhouses during the quarter, ending December 27th, 1856. The deaths in the following Hospitals are included so far as they consisted of persons from this Parish, and they are assigned to the sub-districts from which the parties came. In the last vertical column deductions have been made for cases in which the patients came to the University College and Royal Free Hospitals from other Parishes:— LOCALITIES. Low Fevers. Small Pox. Scarlet Fever. Measles and Hooping Cough. Diarrhæa. Other Causes. Totals. Corrected Totals. Regent's Park 8 .. 4 10 3 129 154 154 Tottenham Court Road 12 .. 2 5 5 129 153 134 Gray's Inn Road 3 .. 7 18 3 113 144 136 Somers Town 8 .. 4 20 3 146 181 181 Camden Town 4 .. 1 8 2 80 95 95 Kentish Town 9 1 8 11 5 132 166 166 Strand Workhouse 1 .. .. 1 36 38 38 St. Pancras Workhouse 3 •• .. 1 1 82 87 87 The whole Parish 47 2 26 73 23 839 1018 1001 The mortality of the Spring, Summer, and Autumn quarters of the past year has been respectively 906, 957, 1001. The increase in mortality, during the late quarter, has been chiefly dependent on the increase in pulmonary * University College, Royal Free, London Fever, Middlesex, and St. Mary's Hospitals. 3 diseases, from the severity of the season. The Autumn quarter is usually more unhealthy than the Summer and Spring quarters. The average mortality of the fourth or Autumn quarter, during the past ten years in St. Pancras, has been 967, which, when raised for increase of population, gives 1,064, considerably more than the actual mortality of the recent quarter. The number of cases of sickness, under the care of the Parochial District Medical Officers, has been, for the three quarters severally, 2,058, 2,332, and 2,001; the numbers of epidemic diseases have been 364, 808, and 316. The total numbers of cases in the first and third quarters have not varied very much; in the Summer quarter there was an excess of 300 over the other quarters, chiefly from diarrhæa and English cholera. The large increase, during the same quarter, of epidemic disease, of which there was more than in the two other quarters combined, was dependent on the same causes. During the last quarter the number of cases of bronchitis, pleurisy, and pneumonia, has increased from 65, in the preceding quarter, to 210. WORKHOUSE. There have been 34 deaths in this establishment during the month. Of these, 5 were under the age of 3 years, and 7 over the age of 70. Six persons have died from natural decay, one at the age of 85. One child, previously very unhealthy, has died of measles, of which disease there has been a considerable number of cases. There have been 12 deaths from chest afflictions, and 5 from cerebral diseases. There have been 2 deaths from puerperal fever, and several persons are now suffering from it. This disease is of a most infectious character; and when once it has gained access to a lying-in ward, it clings to it with remarkable tenacity for some time, in spite of all disinfectants. As soon as the disease made its appearance, Mr. Coster, the Senior Surgeon, with the utmost promptitude, used all precautionary measures to prevent its extension: such as the complete isolation of the patients suffering from it; preventing the nurses, who attend on them, from coming near other parturient women; the entire change of linen and beds; and placing all persons, about to be confined, in a distant part of the building. The disease, however, is not yet eradicated. It is the intention of the Directors not to allow any nurse, who has been near the patients with puerperal fever, to attend lying-in women for three weeks. The Resident Surgeons will not attend any other accouchements for the same period; and all fresh cases of labour will, if possible, be kept at their own houses, or sent to Lying-in Hospitals. 4 This disease frequently co-exists -with erysipelas, and it will be remembered that, in my last Report, I stated that this disease was prevalent in the House, as it is also at the present time. One young woman died in the casual ward unexpectedly, after a short illness, on the 26th December; the cause of her death is the subject of a coroner's inquest. The place at present used for the nightly lodging of the female casual applicants for relief is very much too small for the purpose. The very commodious wards, which have been recently erected for them, are not yet quite fit for use, in consequence of the dampness of the walls, which are, however, being dried as rapidly as possible by means of charcoal braziers. The numbers of casuals have varied during the month from about 40 to 80; on one occasion there were 104. About half of them are usually females. For the short time that the rooms at present in use are obliged to be employed by the casuals, I should recommend that they be on no account occupied during the day, but thoroughly cleaned out, and the windows thrown wide open at 8 o'clock in the morning; and if any of these persons require medical attendance so as to be unfit for work, that they be at onoe admitted to other parts of the House. The average number of inmates (exclusive of casuals) during the month has been 1432. If the number of children removed to Forest Gate be included, namely, 214, the number is still rather less than during last December; so that the House is very much less full than it was last year. The mortality during the past quarter has amounted to 85; in 1855, in the corresponding quarter, it was 109. During the last few days measles of a malignant type has made its appearance amongst the infants; and since last Saturday several children have died of this disease. THOMAS HILLIEE. [ SCHEDULE A. ] St. Pancras, Middlesex.—Deaths during the Four Weeks ending 27th day of December, 1856. Births during: the same period. LOCALITIES. AT WHAT AGES > FROM WHAT CAUSES ? Area in Acres. No. of Inhabited Houses. Population. Deaths in Hospitals. TOTALS. 0 to 3 3 to 5 5 to 10 10 to 15 15 to 20 20 to 30 30 to 40 40 to 50 50 to 60 60 to 70 70 and over._ Low Fevers. # Dysentery and Acute Diarrhoea (not of Infants.) Diarrhæa of Infants. Erysipelas, Pyoemia, and Puerperal Fever. Scarlet Fever. Small Pox. Measles, Hooping Cough, and Croup Bronchitis and Pneumonia of Infants. Convulsions of Infants. Consumption and other tubercular diseases. Violence, Privation, and Poison. Premature Birth and Debility. Other diseases chiefly Chronic. M. F. Totals. M. F. M F. M. F. M.F Regent's Park 427 3575 31918 23 18 .. 1 23 19 42 17 .. 2 2 .. .. 3 2 5 8 3 1 .. 1 .. 1 .. 2 4 1 10 • • 1 21 36 30 66 Tottenham Court Road 145 2586 27933 20 15 13 2 33 17 50 16 2 .. 1 3 4 4 6 4 3 7 4 1 .. 3 .. 1 5 3 3 6 1 23 30 34 70 Strand Union .. .. 500 2 8 .. 2 8 10 3 .. 1 .. .. 1 .. 1 2 2 .. .. .. 1 .. .. .. 1 .. 2 .. .. 6 Gray's Inn Road 155 2940 26523 13 24 1 5 14 29 43 16 2 1 .. 5 1 4 5 .. 3 6 2 .. 1 .. 2 .. 7 3 1 12 .. 1 14 24 35 59 Somers Town 184 3731 35611 98 26 2 3 30 29 59 91 4 2 2 .. 2 2 6 4 5 10 1 .. 2 .. .. .. 5 4 2 7 5 2 31 35 38 73 Camden Town 171 2498 19515 15 22 1 2 16 24 40 12 2 2 .. .. 1 1 5 4 7 5 2 .. 1 1 .. .. 2 4 .. 3 4 .. 24 35 37 72 .. .. 1600 13 ?1 .. .. 13 21 34 5 .. .. .. .. 5 2 3 5 7 7 .. .. .. 2 .. .. ] .. 1 1 .. 2 24 Kentish Town 1634 3248 23326 26 19 .. 1 26 20 46 17 3 2 4 4 2 3 2 3 3 5 .. .. .. .. 2 .. 6 6 3 9 •• 2 18 54 48 102 The whole Parish 2716 18584 166956 140 153 17 14 157 167 324 107 13 9 1012 15 20 29 26 38 45 10 1 5 7 5 •• 24 27 11 50 15 9 161 220 222 442 N.B.—The Divisions are those of the Registrar General, which do not quite correspond with any other divisions. The numbers of houses and of the population are derived from the last Census in 1851. Eight of the deaths in University College Hospital, and three in the Royal Free Hospital, were of persons from other parishes. The Table includes ten deaths of St. Pancras people in the Middlesex, and one in St. Mary's Hospital. [SCHEDULE B ] St. Pancras, Middlesex.—Cases of Sickness under the care of the District Medical Officers during the Four Weeks ending the 27th of December, 1856. Districts. Names of Medical Officers. Total No. of Cases. Low Fevers. Diarrhæa. Dysentery. Influenza. Scarlet Fever. Small Pox. Erysipelas and Pyoemia. Measles. Hooping Cough. Bronchitis, Pleurisy, and Pneumonia. Croup. Consumption. Carbuncles and Boils. Rheumatism. Other Diseases. North-West Mr. Adams 79 4 .. .. 2 2 .. .. 1 .. 7 .. 2 2 4 55 South-West Dr. Wildbore 119 1 .. .. 5 .. . 3 .. 5 21 .. 1 3 13 67 South-East Dr. Davis 134 .. 5 1 .. .. • • 3 11 .. 2 .. 9 .. 4 99 Central Mr. Southerin 93 .. 6 .. .. .. .. 1 3 1 16 .. 2 4 10 50 North Mr. Jefferys 105 7 2 •• 5 8 •• •• 3 •• 11 .. •• 1 2 66 Totals 530 12 13 1 12 10 •• 7 18 6 57 •• 14 10 33 337 REPORT on the SANITARY CONDITION OF SAINT PANCRAS, MIDDLESEX, DURING JANUARY, 1857, by THOMAS HILLIER, M.D., Medical Officer of Health for the Parish of Saint Pancras. February 10th, 1857.] [No. 10. TO THE SANITARY COMMITTEE. Gentlemen— There have been registered in this Parish during the five weeks that ended on the 31st January, 413 deaths, and 612 births. From the number of deaths seven may be deducted for persons who come to University College and the Royal Free Hospitals from other districts, thus giving 406 as the corrected number. The average number of deaths in the corresponding period of the years 1846-56, was 403'6, which, if raised for increase of population, gives 441, considerably above the present return. Diseases of the respiratory organs have been fatal to 88 persons, of whom 38 were under 5 years of age, and 21 over 70 years; tubercular diseases have destroyed 56 persons; and diseases of the nervous system, including 19 cases of convulsions of infants, 50. The diseases called Zymotic, have been fatal to 81 persons; this number includes 20 cases of Measles, 20 of Hooping Cough, 13 of Fever, 5 of Diarrhæa, 7 of Erysipelas, 3 of Puerperal Fever, 4 of Scarlet Fever, and 2 of Small Pox. Measles and Hooping Cough are on the increase. Low Fevers are very much less prevalent than at this time last year; during the past month only 3 persons have been sent to the Fever Hospital at the expense of the Parish, whilst in January, 1856, there were 65 sent. The mean temperature of the five weeks has been 36°.6, which is nearly a degree below the average of ten preceding years. Eighteen days have been colder than usual, and 17 days warmer. The lowest temperature was 180.5 on the 28th December ; and the highest 520.7 on the 2nd January. WORKHOUSE. The number of deaths in this establishment during the month has been 40, of whom 15 were infants under 3 years of age, and 6 over 70 years. There have been 4 deaths from Erysipelas, which is still prevalent in the House; and 2 deaths from Puerperal Fever during the early part of the month. I am happv to report, that there have been no cases of this last disease for several weeks past. At the conclusion of my last Report, I stated that Measles of a malignant type had appeared; during the month there have been 12 deaths from this disease. About 40 of the children have been attacked with it. As this disease is not usually a very fatal one, under favourable hygienic circumstances to children previously healthy, I have been at some pains to ascertain the details of the epidemic. 2 The rooms occupied by the children, previously to the outbreak of the disease, were by no means crowded or badly ventilated; nor was there anything at all objectionable in the diet allowed to the children. The building occupied by them is not so healthy as could be wished, in consequence of washing which is conducted in the basement floor, and the fumes from which traverse that part of the house. This evil will, I presume, be remedied ere long, by the use of the new Laundry. The epidemic commenced in the middle of December. The first case progressed favorably; the second attacked died on 22nd December; another child died on 3lst December; another on the 1st January; another on the 3rd; another on the 4th; another on the 5th; three more on the 7th; one on the 9th; another on the 11th; another on the 12th; then one on the 19th; since which day till the 31st no death occurred. Of those who died, three were under a year old, five between 1 and 2 years, four between 2 and 3, and one in its fourth year. Ten of the children who died were, prior to their having measles, very delicate unhealthy children, none of whom would probably have lived many years under any circumstances. The children who have recovered are for the most part those who have been in the house for the longest period. Of those who died none had been inmates for more than seven months ; in 3 instances their stay in the house was only three weeks; in 2 instances two months ; and in 3 three months. The ages of the children attacked have varied from 3 months to 9 years. Two women have taken the disease, one of whom has died of Pneumonia, secondary to the Measles* The former Boys' School is now in use as an Infirmary, and is found to bo very commodious and well adapted for the purpose. The Building generally is well provided with the means of ventilation; some of the small wards, however, require alteration in this respect. There is one especially to be noted, occupied by old men with bronchial complaints; this room is heated by a gas stove, and has no opsn flue; it would be well that an open fire-place and a ventilator into the chimney should be placed in this room. It is veiy important that some responsible person should be entrusted with the ventilation over the whole house ; and it should be his business to go into every room once, or, in some cases, twice daily, to regulate it according to the weather. The ventilation must be in every case made independently of the inmates, as they will prevent the entry of air in every possible way. In the immediate vicinity of this Infirmary are two wharves, used for thy deposit of refuse from dust-bins and from the roads. The sorting and mixing of this refuse are attended with very offensive and noxious effluvia. In accordance with your instructions these places are indicted as nuisances, and will, it is honed, ere long be cleared out. The average number of inmates during the month has been 1422, at the under-mentioned ages:— Under 6 years. 5 to 10 10 to 20 20 to 30 30 to 40 40 to 50 50 to 60 60 to 70 70 to 80 over 80 73 33 73 111 136 128 154 334 298 67 In January, 1856, the average total number was 1642. THOMAS HILLIER. * For these facts I am indebted to Mr, Andrew, Assistant Surgeon to the Workhouse. [ SCHEDULE A. ] St. Pancras, Middlesex.—Deaths during the Five "Weeks ending the 31st day of January, 1857. Births during the same period. AT WHAT AGES' FROM WHAT CAUSES ? LOCALITIES. Area in Acres. No. of Inhabited Houses. Population. M. F. Deaths in Hospitals. TOTALS. 0 to 5 3 to 5 5 to 10 10 to 15 15 to 20 20 to 30 30 to 40 40 to 50 50 to 60 60 to 70 70 and over. Low Fevers. Dysenterv and Acute Diarrhæa (notof Infants.) Diarrhæa of Infants. Influenza. Scarlet Fever Small Pox. Erysipelas, Pyaemia, and Puerperal Fever. Measles, Hooping Cough, and Croup Bronchitis and Pneumonia of Infants. Convulsions of Infants. Consumption and other tubercular diseases. Violence, Privation, and Poison. Premature Birth and Debility. Other diseases chiefly Chronic. M. F. Totals. M F. M. F. M.F Regent's Park 427 3575 31918 29 34 .. 29 34 63 18 6 3 .. 3 3 4 5 9 11 3 .. .. .. 1 2 .. 7 3 3 6 4 4 30 67 50 117 Tottenham Court Road 145 2586 27933 27 27 5 5 32 32 64 17 1 2 2 •• 7 6 5 8 9 7 .. .. .. .. .. .. 2 6 9 1 12 •• 1 33 32 38 70 Strand Union .. .. 500 6 3 .. .. 6 3 9 3 .. .. .. .. 1 1 .. •• 2 2 .. .. .. .. .. .. .. .. 2 •• 2 •• 1 4 Gray's Inn Road 155 2946 26523 27 20 4 3 31 23 54 25 2 4 - •• 2 3 3 5 4 6 2 1 1 •• 1 •• 1 7 4 6 3 3 3 22 49 37 86 Somers Town 184 3731 35611 38 42 .. 2 38 44 82 36 4 4 2 1 4 5 5 5 10 6 5 •• 2 .. .. .. .. 6 9 5 14 3 7 31 69 63 132 Camden Town 171 2498 19515 13 14 1 .. 13 15 28 12 .. .. .. .. 2 3 2 5 1 3 •• .. .. .. .. .. .. 1 2 1 5 3 1 15 46 40 86 Workhouse .. .. 1600 15 25 .. .. 15 26 40 15 2 .. .. 4 1 8 1 3 6 .. .. .. .. .. .. 6 12 1 •• 2 .. 1 18 Kentish Town 1G34 3248 23326 39 33 .. 1 39 34 73 28 7 2 2 3 3 5 2 4 7 10 3 •• 1 1 2 •• 1 4 7 3 12 4 5 30 82 39 121 The whole Parish 2716 18584 166956 194 198 10 11 204 209 413 154 22 15 6 4 26 27 29 33 45 51 13 1 4 1 4 2 10 43 37 19 56 17 23 183 345 267 612 N.B. -The Divisions arc those of the Registrar General, which do not quite correspond with any other divisions. The numbers of houses and of the population arederived from the last Census in 1851, Seven of the Deaths in Hospitals were of Persons from other Districts whilst Seven others were of Saint Pancras People dying in the Middlesex Hospital. There have been no Deaths during the Month in the London Fever Hospital of Persons from this Parish. [ SCHEDULE B. ] St. Pancras, Middlesex.—Cases of Sickness under the care of the District Medical Officers during the Five Weeks ending the 31st of January, 1857. Districts. Names of Medical Officers. Total No. of Cases. Low Fevers. Diarrhæa. Influenza. Scarlet Fever. Small Pox. Erysipelas and Pyoemia. Measles. Hooping Cough. Bronchitis, Pleurisy, and Pneumonia. Consumption. Carbuncles and Boils. Rheumatism. Other Diseases. North-West Mr. Adams 113 2 1 • • 6 • • 1 2 • • 4 6 . . 8 83 South-West Dr. Wildbore 170 • • .. • • .. 2 1 1 1 28 .. 2 14 121 South-East Dr. Davis 194 .. 9 • • • • .. 2 10 3 2 4 4 8 152 Central Mr. Sutherin 140 2 5 • • .. 1 .. 4 1 25 2 4 8 88 North Mr. Jefferys 100 5 5 4 •• 3 1 1 •• 16 7 6 4 48 Totals 717 9 20 4 6 6 5 18 5 75 19 16 42 492 REPORT on the SANITARY CONDITION OF SAINT PANCRAS, MIDDLESEX, DURING FEBRUARY, 1857, by THOMAS HILLIER, M.D., Medical Officer of Health for the Parish of Saint Pancras. March 10th, 1857.] [No. 11. TO THE SANITARY COMMITTEE. Gentlemen— The total number of deaths registered in this Parish during the month of February was 355. The average for the corresponding four weeks in the ten preceding years is 328, which gives, when raised for increase of population, 361, somewhat more than the actual mortality. During the first week of the month 95 deaths were registered; during the second, 90; during the third, 92; and during the fourth, only 72. Diseases of the respiratory organs were fatal in 100 cases, of which 32 were children under 5, and 10 persons over 80 years of age. The above number does not include 53 cases of consumption. Of zymotic diseases only 59 have died; of these there were 15 cases of measles, 11 of low fever, 7 of hooping cough, and 4 of scarlet fever. Eive children and 1 adult have died of syphilis. Diseases of the nervous system have been fatal to 45 persons, of whom 17 were under 3 years of age. Twenty-two persons have died above the age of 80, a large number when it is considered that at the census of 1851 there were only 644 living in the Parish at that age. WORKHOUSE. There have been 37 deaths in this establishment. Five of these were from measles, which still exist, but the disease is much less virulent than during last month. Puerperal fever has not again made its appearance, and erysipelas has almost disappeared. The general health of the establishment is good. During the month the Lying-in Ward has been much too crowded, but this has now been remedied. The Lunatic Wards, especially for the men, are still much too full. My attention was recently directed to a case of suspected poisoning, from the use of what are called Locust nuts or beans. They have been of late years imported in considerable quantities into this country, as food for cattle. They are also frequently bought by children, and eaten in large quantities on account of their sweetness. They are large brown pods, containing a sweetish pulp, tasting like manna, and dry brown seeds. They are the fruit of a tree belonging 2 to the Leguminous order, called Ceratonia Siliqua or Carob Tree. It grows wild on the coasts of the Mediterranean, and is used by the inhabitants as a cheap food for cattle, especially by the poorer orders. The fruit is not there known to be in any way injurious, except by occasionally causing colic from the accumulation of seeds in the intestines.* In the south of Europe it is also eaten by children. It appears probable that the young man who died in Somers Town, rather suddenly, after eating a number of these beans, died from inflammation of the lungs. The appearances found, post mortem, in his stomach, were dependent not on the use of these beans but on a chronic change. Since this time, another boy, aged ten years, has died in Bolton, with symptoms of acute inflammation of the stomach, a day after eating a number of these beans. The medical man who gave evidence in the case, attributes the death to the use of this fruit, as he was unable to discover any other cause for the symptoms or post mortem appearances; none of the usual irritant poisons could be discovered. The evidence of other persons at the Inquest seemed to indicate that in some persons this fruit caused sickness and diarrhæa, whilst others partook of it with impunity. Whether either of these two deaths was due to the use of these beans is doubtful; but it appears clear that they are not fit for human food, for at the best they are crude, indigestible things, and to say the least, there is a probability that to some persons, or in some conditions of the fruit, they are actually poisonous. I have thought it right to call your attention to this matter, that the public may be informed of the true state of the case as far as it can be ascertained at present.+ It will be seen that the Tables of Mortality for January and February are altered in my present report. The Association of Medical Officers of Health have had the subject of tabular forms under their consideration, and to secure uniformity in the various districts have agreed upon the form (A), which gives, in detail, the names of all diseases, as given by the Registrar General in his Tables. By the use of two tables, namely, A and B, I trust that more valuable results will be obtained, than could be secured by the one which I had previously employed. During the month there have been nine days warmer and nineteen days colder than usual. The highest temperature at Greenwich was on the 28th, being 56°-9. The lowest was on the 1st of the month, 20°. The greatest diurnal range was 27°.2 (from 28°.2 to 55°.4) on the 16th. I remain, Gentlemen, Your obedient Servant, THOMAS HILLIER, M.D., L.R.C.P. 21, Upper gower street. • This information I obtained from my friend, Mr. J. S. Gamgee, who has spent some time in Italy. + Since writing the above, another case has been recorded at Brighton, of severe gastric disorder, in a youth, from drinking an infusion of these beans. [ SCHEDULE A. ] Deaths Registered in Saint Pancras during February, 1857. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. I. Zymotic: Enteritis 2 1 •• 1 Peritonitic Small Pox Aseites Measles 15 15 Ulceration of Intestines Scarlatina 4 4 Hernia (Rupture) 2 .. .. 1 1 Hooping Cough 7 7 Hons 2 1 .. .. 1 Croup 3 3 Intussusception Thrush Stricture of Intestinal Canal Diarrhæa 3 2 .. .. 1 Dysentery Disease of Stomach, &c. 2 .. .. 2 Cholera Influenza Stieture of Intestinal Canal Scurvy and Purpura Disease of Stomach,&c. Ague Disease of Panereas 1 .. .. .. 1 Remittent Fever 1 .. .. 1 Disease of Liver 4 .. .. 1 3 Infantile Fever 4 4 Disease of Spleen 1 1 Typhus Fever 11 7 3 1 Puerperal Fever (Metria) Rheumatic Fever 1 1 VIII. Kidney, &c. ; Erysipelas 3 1 1 .. .. 1 1 .. .. 1 Syphilis 6 5 1 Nephria (Bright's Dis.) Isehuria 4 .. 3 .. 1 Noma (Canker) 1 .. .. 1 Hydrophobia Diabetes II. Dropsy, &c.: Stone Cystitis Hæmorrhage 4 1 •• •• 3 Stricture of Urethra ... Disease of Bladder, &c. 2 .. .. 2 Dropsy Abscess IX. Childbirth : Ulcer Fistula Paramenia Mortification Ovarian Dropsy Cancer 5 4 1 Childbirth (see Metria) Disease of Uterns, &c. 2 .. 2 Gout 1 1 III. Tubercular; X. Joints, Bones, &c. : Scrofula 1 Rheumatism Tabes Mesenterica 3 3 Arthritis Phthisis (Consumption) 53 16 22 13 2 Disease of Joints, &c ... Hydrocephalus 7 7 XI. Skin, Cellular Tissue; IV. Brain and Nerves: Cephalitis 3 1 1 1 Carbuncle 3 .. .. 2 1 Apoplexy r* 1 3 8 1 Phlegmon Palsy (Paralysis) 0 ?, 5 2 Disease of Skin,&c. 1 .. 1 Delirium Tremens XII. Malformations: Chorea Epilepsy Cysanosis Tetanus Spina Bifida Insanity Other Malformations 2 2 Convulsions 15 15 Disease of Brain, &c... 5 3 •• 1 1 XIII. Premature Birth and Debility 12 12 V. Heart and Blood Vessels: XIV. Atrophy 2 2 XV. Old Age 13 .. .. 7 6 Pericarditls XVI. Sudden Anaurism 1 1 XVII. Violent Death: Disease of Heart, &c... 12 1 2 2 6 1 VI. Lungs and Organs of Respiration: Intemperance Privation of Food Want of Breast Milk Laryngitis ? ? Neglect Bronchitis 70 •>1 5 15 ?o 0 Cold Pleurisy Poison 2 2 Pneumonia 15 11 1 ?, 1 Burns and Scalds 1 1 Asthma 10 3 7 Hanging Disease of Lungs 3 1 1 1 Suffocation 2 ?, VII. Stomach and Digestive Organs: Drowing Fractures & Contusions Wounds Other Violence Teething XVIII. Causes not Specified. 1 Quinsey Gastritis Totals 355 156 42 61 72 23 [ SCHEDULE B. ] St. Pancras, Middlesex.—Table for the Four Weeks ending the 28th day of Feb., 1857. LOCALITIES. Deaths. Births. Area in Aeres. No. of Inhabited Houses in 1851. Population in 1851. TOTALS. From 0 to 5 yes's of age. At all other Ages. From Fever. From Diarrhæa. From Scarlet Fever From Small Pox. From Measles. From Hoopnig Cough. From other causes. M. F. Totals. M. F. M.F Regent's Park 427 3575 31918 16 37 53 22 31 . .. 1 3 1 48 35 38 73 Tottenham Court Road 145 2586 27933 31 24 55 18 37 1 1 .. 2 2 49 34 31 65 Strand Union .. .. 500 7 13 20 5 15 .. 1 .. .. .. 19 Gray's Inn Road 155 2946 26523 28 34 62 20 42 1 1 .. 3 2 55 32 37 69 Somers Town .. 184 3731 35641 26 29 55 21 34 3 i .. 2 49 57 56 113 Camden Town 171 2498 19515 8 13 21 7 14 1 .. .. .. .. 20 44 37 81 Workhouse .. .. 1600 12 25 37 5 32 .. .. .. 5 .. 32 Kentish Town 1634 3248 23326 23 29 52 23 29 6 1 2 4 .. 39 65 54 119 The whole Parish 2716 18584 166956 151 184 355 121 234 12 4 4 17 7 311 267 253 520 Of the Deaths in Tottenham District, 18 were in University College Hospital. Of the Deaths in Gray's Inn District, 4 were in the Royal Free Hospital. [ SCHEDULE C. ] St. Pancras, Middlesex.—Cases of Sickness under the care of the District Medical Officers dining the Four Weeks ending the 28th of February, 1857. Districts. Names of Medical Officers. Total No. of Cases. Low Fevers. Diarrhæa. Dysentery. Scarlet Fever. Small Pox. Erysipelas and Pyoemia. Measles. Hooping Cough. Bronchitis, Pleurisy, and Pneumonia. Consumption. Carbuncles and Boils. Rheumatism. Other Diseases. North-West Mr. Adams 130 1 . . 1 7 3 1 2 .. 7 1 . . 3 104 South-West Dr. Wildbore 149 1 . . . . 4 3 2 2 3 21 •• 2 12 99 South-East Dr. Davis 143 3 2 1 3 . . 1 2 •• 8 5 3 9 106 Central Mr. Sutherin 114 5 10 .. 1 . . 3 . . 1 24 3 2 3 62 North Mr. Jefferys 114 6 2 . . 3 1 1 5 1 18 5 2 5 65 Totals.. 650 16 14 2 18 7 8 11 5 78 14 9 32 436 REPORT on the SANITARY CONDITION OF SAINT PANCRAS, MIDDLESEX, DURING MARCH, 1857, by THOMAS HILLIER, M.D., Medical Officer of Health for the Parish of Saint Pancras. April 3rd, 1857.] [No. 12. TO THE SANITARY COMMITTEE. Gentlemen— The total number of deaths registered in this Parish during the four weeks that ended on the 28th March last was 351. The average for the corresponding period of ten preceding years, corrected for increase of population, is 356; so that the present return of mortality is a very little below the average. There have been 152 deaths under the age of 5 years, and 17 above the age of 80; one of these list at the age of 94. Diseases of the zymotic class have been fatal to 62 persons; amongst these there were 12 cases of measles, 9 of scarlatina, 11 of hooping cough, 6 of diarrhoea, 9 of low fever, 3 of erysipelas, and 2 of small pox in children not vaccinated. There have been 62 deaths from tubercular disease, and 42 from affections of the nervous system. Diseases of the respiratory organs were fatal in 79 cases, of which 31 were of children under 5, and 24 of persons over 60 years of age. WORKHOUSE. There have been 37 deaths here. Three of these were from measles, and 2 from hooping cough. The average number of inmates during the month has been 1469. This number includes the casual applicants for relief, who are, under the new system, entered on the books and counted as inmates, whereas, until the new wards were open, there was no regular return of these given. Temperature.—The highest temperature registered at Greenwich during the month was 66.2° on the 18th, and the lowest 27.7° on the 22nd. There have been 14 days above and 14 days below the average temperature. The greatest diurnal range was 22.7° (from 32-3° to 55°) on the 1st of the month. I remain, Gentlemen, Your obedient Servant, THOMAS HILLIER, M.D., L.R.C.P. 21, Upper Gowee Street. [ SCHEDULE A. ] St. Pancras, Middlesex—Table for the Four Weeks ending the 28th day of March 1857. LOCALITIES. Area in Aeres. Population in 1851. Births. Deaths From all causes. From all causes under 5 years of age. | From Small Pox. From Measles. I From Scarlatina. [From Hooping Cough. | From Diarrhoea. | From Low Fever. M. F. M.&F. M. F. M. & F. Regent's Park 427 31918 45 42 87 28 33 61 28 4 1 3 1 2 Tottenham Court 145 27813 41 21 21 42 19 1 . 2 . 1 University College Hospital 500 32 73 3 2 5 .. . . Strand Union 120 7 4 11 3 3 Gray's Inn Road 155 26462 38 26 21 47 20 1 1 45 83 Royal Free Hospital 60 2 1 3 •• •• •• •• •• •• •• Somers Town 184 35641 58 53 111 28 36 64 25 2 •• 2 4 2 3 Camden Town 171 19515 16 14 30 17 1 1 1 28 69 St. Pancras Workhouse 1600 14 23 37 10 • • 3 .. 2 Kentish Town 1634 23326 61 47 108 20 31 51 30 .. 6 .. .. 1 Middlesex Hospital 2 1 3 Totals 2716 166956 284 247 531 167 187 354 152 2 12 9 11 5 9 Two of the Deaths in University College Hospital and two of those in the Royal Free Hospital were of Peisons from other Districts. [ SCHEDULE B. ] Deaths Registered in Saint Pancras during March, 1857. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. I, Zymotic : Enteritis 2 1 .. .. 1 Peritonitis 4 1 I 2 Small Pox 2 2 Aseites 2 .. .. 1 1 Measles 12 12 Ulceration of Intestines Hernia (Rupture) 2 .. 1 •• 1 Scarlatina 9 9 Hooping Cough 12 Croup 2 2 Hens Thrush 1 1 Intussuscption Diarrhæa 6 4 .. .. 2 Stricture of Intestinal Canal 1 .. .. .. 1 Dysentery Cholera Disease of Stomach,&c. Influenza Disease of Panereas Scurvy and Purpura 1 .. .. .. 1 Inflammation of Liver (Hepatitis) Ague .. Remittent Fever Jaundice 4 .. 1 .. 3 Infantile Fever 1 i Disease of Liver Typhus Fever 8 4 2 1 .. 1 Disease of Spleen Puerperal Fever (Metria) 8 .. 2 VIII. Kidney, &c.; Rheumatic Fever 1 .. 1 Erysipelas 3 1 1 .. .. 1 Nephritis Syphilis 2 2 Nephria (Bright's Dis.) 2 .. .. 1 1 Noma (Canker) Isehuria Hydrophobia Diabetes 1 .. .. 1 II. Dropsy, &c.: Stone Cystitis 1 .. 1 Hæmorrhage 2 2 Stricture of Urethra Disease of Bladder, &c. 1 .. .. .. 1 Dropsy 4 .. .. .. 4 Abscess 2 1 1 IX. Childbirth : Ulcer Paramenia Mortification 1 .. .. 1 Ovarian Dropsy Cancer 6 .. .. 4 2 Childbirth (see Metria) Disease of Uterns, &c. Gout III. Tubercular; X. Joints, Bones, &c. : Serofula ?, 2 Rheumatism Tabes Mesenterica 7 7 Arthritis Phthisis (Consumption) Hydrocephalus 45 6 21 18 Disease of Joints, &c 1 .. .. 1 8 8 XI. Skin, Cellular Tissue; IV. Brain and Nerves: Cephalitis 5 3 .. 1 1 Carbuncle Apoplexy 9 3 2 3 1 Phlegmon Palsy (Paralysis) 5 .. .. .. 5 Disease of Skin, &c. 1 1 Delirium Tremens XII. Malformations: Chorea Epilepsy 4 1 2 1 Cyanosis Tetanus Spina Bifida Insanity 13 13 Other Malformations Disease of Brain, &c 6 3 1 .. 2 XIII. Premature Birth and Debility 10 10 V. Heart and Blood Vessels; XIV. Atrophy 5 5 XV. Old Age 6 .. .. .. 6 Pericarditis Aneurism 1 .. .. .. 1 XVII. Violent Death: Disease of Heart, &c 19 1 .. 6 10 2 VI. Lungs and Organs op Respiration: Intemperance Privation of Food Want of Breast Milk Laryngitis 1 .. .. .. .. 1 Neglect Bronchitis 51 16 1 11 20 3 Cold Pleurisy Poison Pneumonia 2 22 .. 1 Burns and Scalds 1 1 Asthma Hanging Disease of Lungs 4 2 1 1 Suffocation 5 5 Drowning VII. Stomach and Di- gestive Organs; Fractures & Contusions 4 2 1 .. 1 Wounds 1 1 Teething 4 4 Other Violence 1 1 Causes not Specified 1 1 Quinsev Chloroform 1 ,. .. •• 1 Gastritis Chloroform 351 173 39 53 6 17 [ SCHEDULE C. ] St. Pancras, Middlesex.—Cases of Sickness under the care of the District Medical Officers during the Four Weeks ending the 28th of March, 1857. Districts. Names of Medical Officers. Total No. of Cases. Low Fevers. Diarrhæa. Scarlet Fever. Small Pox. Erysipelas and Pyæmia. Measles. Hooping Cough. Bronchitis, Pleurisy, and Pneumonia. Consumption. Carbuncles and Boils. Rheumatism. Other Diseases. North-West Mr. Adams 98 2 .. 5 .. .. 2 1 7 6 .. 1 74 South-West Dr. Wildbore 168 3 1 1 4 1 2 .. 42 1 1 7 105 South-East Dr. Davis 111 1 2 .. .. 3 1 1 18 4 .. 8 73 Central Mr. Sutherin 101 4 5 .. 1 1 .. .. 24 2 1 5 59 North Mr. Jefferys 109 2 •• 2 •• •• 6 •• 18 4 •• 5 71 Totals 587 12 8 8 5 5 11 2 109 17 2 26 382 14 REPORT on the SANITARY CONDITION OF SAINT PANCRAS, MIDDLESEX, DURING APRIL, 1857, by THOMAS HILLIER, M.D., Medical Officer of Health for the Parish of Saint Pancras. Mat 12th, 1857.] [No. 13. TO THE SANITARY COMMITTEE. Gentlemen— The total number of deaths registered in Saint Pancras during the five weeks that ended on the 2nd May was 384. (See Schedule B.) The average mortality during the corresponding periods of the ten immediately preceding years is 382 9, which becomes, if corrected for an increased population, 421. The present return, therefore, shows a favorable state of the public health. 147 children have died under 5 years of age, and 21 persons have died above the age of 80 years. Of zymotic diseases Hooping cough has been the most fatal, having destroyed 22 children; Low Fevers have been fatal in 13, Scarlatina in 12, Measles in 8 (See Schedule A.) There has been no death from Small Pox, although the disease has been rather prevalent in Somers Town sub-district. Diseases of the respiratory organs were fatal in 80 cases, to be compared with 79 deaths in four weeks of March. Of the 80 cases, 38 were children under 5, and 18 of persons over 60 years of age. There have been 74 deaths from tubercular diseases. WORKHOUSE. There have been during the five weeks 31 deaths in the Workhouse. Of these there was only one case of epidemic disease, namely, Hooping cough. The general health of the inmates has been satisfactory. The average number has been 1475. There have been no admissions to the Eever Hospital from this Parish during the month. Temperature.—The highest temperature registered at Greenwich was 69° on the 19th of April; the lowest was 28 2° on the 24th of the month. From the 23rd of April, cold Easterly or North-easterly winds have been prevalent. The greatest diurnal range of temperature was 27° (from 33° to 60°), on the 17th of 2 the month. The average temperature of the 1st and 2nd weeks was about 4.4° above the average, whilst that of the 3rd, 4th, and 5th weeks was 0.6°, 2.3°, and 7.5° below the respective averages of corresponding weeks. I must again call your attention to the open drain in Winchester Terrace, Agar Town, on which I reported 12 months ago, and to which I have on several occasions referred. Low Fever and Diarrhoea are again making their appearance in this place, and as the season advances, unless the ditch be covered over, very serious consequences may be apprehended. I trust that the Vestry will without delay remedy the evil. REVIEW OF THE WINTER QUARTER. The total number of deaths registered in the Parish during the quarter ending 28th March, 1S57, was 1112, whilst in the corresponding quarter of 1855 the number was 995, and the corrected average of ten previous years is 1161. The increase on last year is chiefly dependent on pulmonary diseases; there was an excess of 86 deaths amongst children under 5 years of age, and of 34 amongst persons over 60, showing that at other ages the mortality was about the same as last year. The mean temperature of the quarter as observed at Greenwich was nearly 39°—about the average of other winter quarters; but the fifth and sixth weeks were very cold—considerably below the average. The mortality from small pox, scarlatina, and hooping cough, severally, has been less thau in the first quarter of 1856 or of 1855. The registered deaths from measles, diarrhoea, and fever, have been more than in either of the two previous years; but if it were concluded from this that fever has been more prevalent than last year a very wrong impression would bo made, for in 1856 during the winter quarter 142 St. Pancras people went to the Fever Hospital, nearly all with fever, and of these 30 died, whilst during the late quarter only 15 went there and there were no deaths; so that by making a correction for this circumstance the numbers of fever deaths of St. Pancras residents in 1856 and 1857 become, instead of 27 and 33, 57 and 33 respectively. In accordance with the last fact is the experience of the District Surgeons, who in the first quarter of 1856 treated 120 cases of low fever, whilst in the corresponding quarter of 1857 they have only treated 37 cases. Annexed are the several tables for the month of April and the winter quarter. I remain, Gentlemen, Your obedient Servant, THOMAS HILLIER, M.D., L.R.C.P. 21, Upper Gower Street. [ SCHEDULE A. ] St. Pancras, Middlesex,—Table for the Five Weeks ending the 2nd day of May 1857 LOCALITIES. Area in Acres. Population in 1851. Births. Deaths From all causes. From all causes under 5 years of age. From Small Pox. From Measles. From Scarlatina. From Hooping Cough. From Diarrhcea. From Low Fever. M. F. M.&F. M. F. M. & F. Regent's Park 427 31918 51 68 119 41 34 75 38 3 6 4 .. 1 Tottenham Court 145 27813 56 50 106 25 29 54 26 • .. 1 8 •• 3 University College Hospital 500 7 5 12 Strand Union 120 8 11 19 2 • 1 .. .. 1 Gray's Inn Road 155 26462 45 37 82 21 22 43 17 . •• 1 4 1 Royal Free Hospital 60 2 3 5 .. Somers Town 184 35641 55 75 130 33 38 71 27 . 3 2 3 1 1 Camden Town 171 19515 31 35 66 13 12 25 13 . 1 2 .. 3 St. Pancras Workhouse 1600 10 21 31 6 . . . 1 Kentish Town 1634 23326 57 64 121 25 24 49 18 • 1 2 .. . 4 Middlesex Hospital 3 2 5 Totals 295 329 624 188 201 389 147 . 8 13 22 2 31 Two of the Deaths in University College Hospital and all those in the Royal Free Hospital were of Persons from other Districts. [ SCHEDULE B.] Deaths Registered in Saint Pancras during Five Weeks ending May 2nd, 1857. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. L Zymotic : Enteritis Small Pox Peritonitis Measles 8 8 Ascites 1 .. .. 1 Scarlatina 12 12 Ulceration of Intestines 1 .. .. .. .. 1 Hooping Cough 22 22 Hernia (Rupture) I .. .. .. 1 Croup 3 3 Ileus Thrush 2 2 Intussusception Diarrhœa 2 1 .. .. 1 Stricture of Intestinal Dysentery 1 .. 1 Canal 1 .. .. .. 1 Cholera Disease of Stomach, &c 1 .. .. .. 1 Influenza 1 1 Disease of Pancras Scurvy and Purpura Inflammation of Liver (Hepatitis) 1 .. .. 1 Ague Remittent Fever Jaundice 1 .. .. 1 Infantile Fever 4 4 Disease of Liver 3 .. 1 1 Typhus Fever 11 5 2 1 2 1 Disease of Spleen Puerperal Fever (Metria) VIII. Kidney, &c.; Rheumatic Fever 2 1 .. 1 Erysipelas 5 1 .. 1 3 Nephritis Syphilis 6 4 2 Nephria (Bright's Dis.) 3 .. 1 1 1 Noma (Canker) Ischuria Hydrophobia Diabetes II. Dropsy, &c.: Stone 1 .. .. .. .. 1 Cystitis Hæmorrhage Stricture of Urethra Dropsy 3 .. .. 2 1 Disease of Bladder, &c Abscess 7 3 1 1 1 1 Ulcer 2 .. 2 IX. Childbirth: Fistula Paramenia Mortification 2 .. .. .. 2 Ovarian Dropsy 1 .. 1 Cancer 12 .. .. 5 7 Childbirth (see Metria) 1 .. 1 Gout 1 .. .. .. 1 Disease of Uterus, &c. 1 .. . 1 III. Tubercular; X. Joints, Bones, &c.: Scrofula 4 3 1 Rheumatism 1 .. .. 1 Tabes Mesenterica 4 4 Arthritis Phthisis (Consumption) 56 10 22 22 2 Disease of joints, &c. 1 .. 1 Hydrocephalus 10 10 IV. Brain and Nerves: XI. Skin, Cellular Tissue; Cephalitis 4 1 1 2 Carbuncle 1 .. .. 1 Apoplexy 14 1 2 3 8 Phlegmon Palsy (Paralysis) 11 .. 2 2 4 3 Disease of skin, &c. Delirium Tremens Chorea XII. Malpormations: Epilepsy 1 .. 1 Tetanus Cyanosis Insanity 1 .. .. 1 Spina Bifida Convulsions 7 7 Other Malformations 2 2 Disease of Brain, &c. 5 2 1 .. 2 XIII. Premature Birth V. Heart and Blood vessels: and Debility 8 8 XIV. Atrophy 10 10 XV. Old Age 20 .. .. .. 9 11 Pericarditis XVI. Sudden Aneurism 2 .. .. 2 Disease of Heart, &c 8 .. .. 5 3 XVII. Violent Death: VI. Lungs and Organs of respiration:, Intemperance Privation of Food Want of Breast Milk 1 1 Laryngitis 4 4 Neglect Bronchitis 49 19 1 14 13 2 Cold Pleurisy Pioson Pneumonia 22 18 1 2 1 Burns and Scalds Asthma 2 .. .. 1 .. 1 Hanging Disease of Lungs 3 .. 1 1 1 Suffocation VII. Stomach and Digestive Organs; Drowning Fractures & Contusions 1 .. .. 1 Wounds 2 1 .. .. 1 Teething 5 5 Other Violence Quinsey 2 1 1 Gastritis Totals 384 173 47 76 67 21 [ SCHEDULE C ] St, Pancras, Middlesex.--New Cases of Sickness coming under the care of the Parochial Medical Officers during the Five Weeks ending the 2nd of May 1857. Districts. Names of Medical Officers. Total No. of Cases. Low Fevers. Diarrhoea. Scarlet Fever. Small Pox. Erysipelas and Pyoemia. Measles. Hooping Cough. Bronchitis, Pleurisy, and Pneumonia. Carbuncles. , Rheumatic Fever. Other Diseases. North-West Mr. Adams 98 . . i 5 .. .. 1 .. 17 1 .. 63 South-West Dr. Wildbore 149 1 .. 4 1 1 15 5 28 .. .. 104 South-East Dr. Davis 125 1 9 4 .. 2 .. .. 14 .. 1 94 Central Mr. Sutherin 100 1 8 1 .. .. 2 4 14 .. 1 69 North Mr. Jefferys 102 2 2 .. .. .. 1 .. 18 .. 79 Workhouse and Infirmary Mr. Coster and Mr. Andrew 88 .. 1 .. .. 1 .. 7 16 2 1 60 Totals 662 5 21 14 1 4 19 16 107 3 3 469 [QUARTERLY TABLE No. I.] St. Pancras, Middlesex.—Table for the 13 Weeks ending the 28th day of March, 1857. LOCALITIES. Area in Acres. Population in 1851. Births. Deaths From all causes. From all causes under 5 years of age. | From Small Pox. From Measles. From Scarlatina. From Hooping Cough. From Diarrhoea. | From Low Fever. M. F. M.&F. M. F. M.&F. Regent's Park 427 31918 147 130 277 73 104 177 72 2 10 3 7 1 4 Tottenham Court 145 27813 107 101 208 66 66 132 53 5 .. 8 1 2 University College Hospital 500 19 13 32 1 Strand Union 120 21 20 41 11 3 .. .. 1 Gray's Inn Road 155 26462 119 119 238 79 74 153 64 3 1 8 4 4 Royal Free Hospital 60 7 4 11 2 Somers Town 184 35641 184 172 356 92 107 199 84 2 2 3 10 5 11 Camden Town 171 19515 131 100 231 37 41 78 36 2 . .. 1 2 St. Pancras Workhouse 1600 41 73 114 32 20 . 2 Kentish Town 1634 23326 208 140 348 82 93 175 89 4 10 2 2 10 Middlesex Hospital 6 4 10 Totals 896 762 1658 523 599 1122 444 4 49 17 37 14 33 Corresponding Quarter in 1856 1583 995 358 9 10 25 50 7 27 [ QUARTERLY TABLE No. II. ] Deaths Registered in Saint Pancras during 13 Weeks ending March 28th, 1857. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. I. Zymotic : 202 164 16 8 9 5 Enteritis Peritonitis Small Pox Ascites Measles Ulceration of Intestines Scarlatina Hernia (Rupture) Hooping Cough llens Croup Intussusception Thrush Stricture of Intestinal Canal Diarrhœa Disease of Stomach, &c. Dysentery Disease of Pancras Cholera Influenza Inflammation of Liver (Hepatitis) Scurvy and Purpura Ague Jaundice Remittent Fever Disease of Liver Infantile Fever Disease of Spleen Typhus Fever Puerperal Fever (Metria) VIII. Kidney, &c. ; 20 2 4 8 6 Rheumatic Fever Erysipelas Nephritis Syphilis Nephria (Bright's Dis.) Noma (Canker) Ischuria Hydrophobia Diabetes Stone II. Dropsy, &c.: 40 5 2 15 17 1 Cystitis Hæmorrhage Stricture of Urethra Dropsy Disease of Bladder, &c. Abscess IX. Childbirth: 4 •• 2 •• 2 Ulcer Fistula Paramenia Mortification Ovarian Dropsy Cancer Childbirth (see Metria) Gout Disease of Uterus, &c. III. Tubercular; 182 77 64 37 4 X, Joints, Bones, &c.: 5 .. .. 2 2 1 Scrofula Rheumatism Tabes Mesenterica Arthritis Phthisis (Consumption) Disease of Joints, &c Hydrocephalus XI. Skin, Cellular Tissue; 6 1 1 2 2 IV. Brain and Nerves: 137 65 8 20 39 5 Cephalitis Carbuncle Apoplexy Phlegmon Palsy (Paralysis) Disease of Skin, &c. Delirium Tremens XII. Malformations: 3 3 Chorea Epilepsy Cyanosis Tetanus Spina Bifida Insanity Other Malformations Convulsions Lisease of Brain, &c XIII. Premature Birth 39 V, Heart and Blood Vessels: 48 2 6 15 21 4 XIV. Atrophy 18 17 1 XV. Old Age 50 1 27 22 XVI. Sudden 1 1 Aneurism XVII. Violent Death: 38 20 7 5 5 Disease of Heart, &c VI. Lungs and Organs of Respiration: 267 117 16 50 69 15 Intemperance Privation of Food Want of Breast Milk Laryngitis Neglect Bronchitis Cold Pleurisy Poison Pneumonia Burns and Scalds Asthma Hanging Disease of Lungs Suffocation Droning VII. Stomach and Digestive Organs; 46 11 5 11 18 1 Fractures & Contusions Wounds Other Violence Teething Causes not specified 6 5 Quinsey Totals 1112 529 132 174 221 54 Gastritis Two deaths registered were of persons whose ages were not given. QUARTERLY TABLE, No. III. St, Pancras, Middlesex.—Cases of Sickness coming under the care of the District Medical Officers during the Thirteen Weeks ending the 28th of March 1857. Districts. Names of Medical Officers. Total No. of Cases. Low Fevers. Diarrhoea. Dysentery. Influenza. Scarlet Fever. Small Pox. Erysipelas and Pyaemia. Measles. Hooping Cough. Bronchitis, Pleurisy and Pneumonia. Carbuncles and Boils. Consumption. Rheumatism. Other Diseases. North-West Mr. Adams 341 5 1 1 .. 18 3 2 6 1 18 .. 13 12 261 South-West Dr. Wildbore 487 4 1 .. .. 5 9 4 5 4 91 5 1 33 325 South-East Dr. Davis 448 4 13 1 .. 3 .. 6 13 4 28 7 13 25 331 Central Mr. Sutherin 355 11 20 .. .. 1 2 4 4 2 73 7 7 16 208 North Mr. Jefferys 323 13 7 .. 4 5 4 2 12 1 52 8 16 14 185 Totals 1954 37 42 2 4 32 18 18 40 12 262 27 50 100 1310 REPORT on the SANITARY CONDITION OF SAINT PANCRAS, MIDDLESEX, DURING- MAY, 1857, BY THOMAS HILLIER, M.D., Medical Officer of Health for the Parish of Saint Pancras. June 9th, 1857.] No. 14. TO THE SANITARY COMMITTEE. Gentlemen— The number of deaths registered in this district during the four weeks ending on the 30th of May, was 283, distributed over the four weeks as follows: in the first week 86, in the second 70, in the third 67, and in the fourth 60; so that each week has had a lower mortality than the one immediately preceding. The average mortality during the corresponding weeks of the ten years, 1847-1856, was 283.4, which becomes, if corrected for the increase of population, 311.7. So that the present mortality is 10 per cent. below the corrected average. This improved state of the public health has been noted throughout the metropolis as a whole in about the same ratio as in this Parish. Of the zymotic diseases, hooping cough has been again the most fatal, giving 13 deaths, less however than in the month of April. Scarlatina has been fatal in only 3 cases; last month (five weeks) in 12 cases. Measles have been fatal to 6 children. Low fevers have caused 9 deaths. Small pox has been fatal to one child whose parents would not allow it to be vaccinated. Two other members of the family, also unvaccinated until the disease was in the house, have had the disease in a virulent form, but are expected to recover. There have been 4 deaths from diarrhoea in children. Diseases of the respiratory organs have been much less fatal than last month, as might be expected since the weather has been warmer. There have been 47 deaths in four weeks, to be compared with 80 in five weeks. From tubercular diseases, too, instead of 74 deaths in five weeks, there have been only 48 in four weeks. In the workhouse there have been 25 deaths, chiefly from chronic diseases. The general health of the inmates has been good; but as the season advances diarrhoea is becoming more frequent, but at present in a mild form. There have been 22 cases this month, whilst last month there was only one. The average number of inmates in the house during the month was 1,425. Temperature.—The average of the first week was 6.7° below the average of corresponding weeks in other years; the second 5.9° above, the third 5.3° above, and the fourth 1.9° above the several averages of corresponding weeks. Nine days were colder and nineteen were warmer than usual. The lowest 2 perature was 31.5° on the 4th May; the highest 80.2° on the 16th. The greatest range of temperature during twenty-four hours was on the 18th May, from 45° to 79°, being 34. But very little rain has fallen during the month ; during the first week there was none; during the second, third, and fourth weeks a total of only 0.55 of an inch, measured at Greenwich. The effect of the dry warm weather has been to diminish the amount of water coming down the rivers Lea and Thames, which supply London with water. This has been measured on the weir at Stonebridge Lock in the Lea, where the depth of water has fallen from 6.l inches on the 11th April to 3.7 inches on the 23rd May. If the amount of solid impurity poured into these rivers above the points at which they supply water to London be assumed to remain nearly constant, since the quantity of water is much reduced, a given quantity of drinking water must contain much more solid impurity than it did six weeks ago. This circumstance, first noted by the Officer of Health for St. George in the East, may be fairly expected to exercise in connexion with other things an important influence on the health of the metropolis, especially in reference to the amount of diarrhoea, during the summer months. In the "Workhouse the Inmates drink Well water, which is not liable to such sudden changes, yet here diarrhoea has much increased as stated above, so that the concentration of impure water is only one amongst many causes. On the accompanying Schedules the mortality and pauper sickness of the month are shown as usual. I remain, Gentlemen, Tour obedient Servant, THOMAS HILLIER, M.D., L.R.C.P. 21, TTppee Gowee Steeet. [ SCHEDULE A. ] St. Pancras, Middlesex,—Table for the 4 Weeks ending the 30th day of May, 1857. LOCALITIES. Area in Acres. Population in 1851. Births, Deaths From all causes. From all causes under 5 years of age. From Small Fox. From Measles. From Scarlatina. From Hooping Cough. From Diarrhoea. From Low Fever. M. F. M.&F. M. F. M.&F. Regent's Park 427 31918 43 47 90 19 30 49 20 1 .. 4 1 1 Tottenham Court 145 27813 35 31 66 15 19 34 17 .. 7 .. 2 University College Hospital 500 5 6 11 1 Strand Union 120 3 8 11 Gray's Inn Road 155 26462 139 27 66 15 21 36 15 •• 2 •• •• 1 Royal Free Hospital 60 2 2 4 •• 1 1 Somers Town 184 35641 58 56 114 20 25 45 19 1 1 1 .. 3 Camden Town 171 19515 30 37 67 18 10 28 10 .. 1 1 .. 1 St. Pancras Workhouse 1600 10 15 25 2 Kentish Town 1634 23326 38 60 98 23 17 40 15 .. 2 1 1 1 1 Middlesex Hospital 3 3 6 Totals 1243 258 501 133 156 289 99 1 6 313 4 9 [ SCHEDULE B. ] Deaths Registered in Saint Pancras during 4 Weeks ending May 30th, 1857. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. I. Zymotic : Enteritis 2 1 1 Peritonitis 1 .. .. 1 Small Pox 1 1 Ascites 1 .. .. 1 Measles 0 Ulceration of Intestines Scarlatina 3 3 Hernia (Kupture) 1 .. .. 1 Hooping Cough Ileus Croup 3 Intussusception Thrush 2 Stricture of Intestinal Canal Diarrhœa 4 4 Dysentery Disease of Stomach Cholera Disease of Pancreas Influenza Inflammation of Liver (Hepatitis) Scurvy and Purpura Ague I •• 1 Jaundice Remittent Fever Disease of Liver 4 2 .. 2 Infantile Fever 2 Disease of Spleen Typhus Fever 4 1 • • 2 VIII. Kidney, &c.; Puerperal Fever (Metria) I 1 Rheumatic Fever 2 .. 2 Erysipelas 1 .. .. 1 Nephritis 2 .. 1 • • 1 Syphilis 3 2 • 1 Nephria (Bright's Dis.) 3 • • • • 2 1 Noma (Canker) Ischuria Hydrophobia Diabetes Stone II. Dropsy, &c.: Cystitis Hæmorrhage Stricture of Urethra 1 .. .. .. 1 Disease of Bladder, &c. 1 .. .. .. 1 Dropsy •• IX. Childbirth: Abscess Ulcer Paramenia Fistula 1 • • .. 1 Mortification Ovarian Dropsy Cancer 11 .. 1 5 4 1 Childbirth (see Metria) Gout 1 1 Disease of Uterus, &c. 1 •• •• 1 III. Tubercular; X. Joints, Bones, &c.: Scrofula Rheumatism Tabes Mesenterica 2 2 Arthritis Phthisis (Consumption) 86 5 18 11 2 Disease of Joints, &c. 3 • • • • 1 2 • • Hydrocephalus 10 10 XI. Skin, Cellular Tissue; IV. Brain and Nerves: Cephalitis 1 1 Carbuncle Apoplexy 7 2 1 4 Phlegmon Palsv (Paralysis) 5 .. . 4 1 Disease of Skin, &c. Delirium Tremens 1 .. 1 XII. Malformations: Chorea Epilepsy 3 1 1 1 Cyanosis Tetanus Spina Bifida Insanity Other Malformations Convulsions 8 Disease of Brain, &c. 2 2 XIII. Premature Birth and Debility 9 9 V. Heart and Blood Vessels; XIV. Atrophy 8 7 .. .. 1 XV. Old Age 33 . .. 1 21 11 Pericarditis 1 .. 1 XVI. Sudden Aneurism XVII. Violent Death: Disease of Heart, &c. 13 2 1 5 5 VI. Lungs and Organs of Respiration: Intemperance Privation of Food Want of Breast Milk Laryngitis 4 3 .. 1 Neglect Bronchitis 24 9 4 8 3 Cold Pleurisy Poison Pneumonia 14 9 3 2 Burns and Scalds 2 1 .. I Asthma 1 .. .. .. 1 Hanging Disease of Lungs 4 1 •• 2 1 Suffocation Drowning VII. Stomach and Digestive Organs; Fractures & Contusions 3 1 2 Wounds Other Violence Teething 1 1 Causes not Specified Quinsey Totals 283 117 37 51 62 16 Gastritis SCHEDULE C. St. Pancras, Middlesex.—New Cases of Sickness coming under the care of the Parochial Medical Officers during the Four Weeks ending the 30th of May, 1857. Districts. Names of Medical Officers. Total No. of Cases. Low Fevers. Diarrhoea. Dysentery. Influenza. Scarlet Fever. Small Pox. Erysipelas and Pyœmia. Puerperal Fever. Measles. Hooping Cough. Bronchitis, Pleurisy, and Pneumonia. Carbuncles and Boils. Rheumatic Fever. Other Diseases.[/### North-West Mr. Adams 79 ,. 2 .. .. 2 .. .. .. 5 2 6 1 .. 61 South-West Dr. wlldbore 131 3 .. .. .. 1 •• .. .. 7 3 101 .. .. 101 South-East Dr. Davis 96 2 8 .. .. 2 •• 2 • • 1 6 9 1 .. 65 Central Mr. Suthekin 75 4 4 .. .. .. 1 1 1 7 7 6 .. 1 43 North Mr. Jeferys 85 4 3 .. .. .. •• 1 .. 4 1 7 .. .. 65 Workhouse Mr. Coster 121 •• 22 .. .. •• .. 5 .. •• 3 22 •• 3 66 Totals 587 13 39 1. 5 1 9 1 24 22 6 2 4 401 REPORT on the SANITARY CONDITION OF SAINT PANCRAS, MIDDLESEX, DURING' JUNE, 1857, by THOMAS HILLIER, M.D., Medical Officer of Health for the Parish of Saint Pancras. July 6th, 1857.] [No. 15. TO THE SANITARY COMMITTEE. Gentlemen— Two hundred and sixty-six deaths were registered in Saint Pancras during the four weeks that ended on the 27th June. • The average number of deaths in the corresponding periods of the ten years immediately preceding was 272.7, so that the present mortality is less than the average, even without allowing tor increase of population. Hooping cough has been again the most fatal amongst zymotic diseases, giving 15 deaths; there have been 7 deaths from low fevers, 6 from diarrhoea, 8 from measles, 3 from scarlatina and malignant sore throat, 1 from small pox, and 4 from croup. Tubercular diseases have been fatal to 61 persons; diseases of the respiratory organs have caused 30 deaths (last month there were 47); diseases of the nervous system have been fatal in 41 cases (last month only 27). This last number includes 4 deaths from delirium tremens, the result of drink ; one of a man only nineteen years of age. There was, too, a death produced by choking whilst in a state of intoxication. In several other cases during the last month I have had proof that excess of alcoholic drinks has tended very much to hasten the death. Of the whole number of deaths 128 were of persons under 20 years of age, and 103 under 5 years, and 10 were above 80 years. Small pox though only fatal in one case has continued since the beginning of May to prevail in Somers Town, and is still rife there. During the late quarter only two have died of this disease, both unvaccinated. The disease has in the present case spread, it is believed, in great measure from a family whose parents objected to their being vaccinated.* It is high time that the Vaccination Act was rendered more effective. During the month three cases have been sent to the Fever Hospital, of whom one has died. * Since this was written two other deaths have occurred from small pox of children unvaccinated in Little Clarendon Street. There is a third child, of the same family, lying in a very precarious state with the same disease, and in this crowdcd locality, it is much to be feared, that many more will have the disease. 2 WORKHOUSE. There have been 26 deaths in this Establishment. In the corresponding month of 1856 there were 30. During the quarter just ended there have been 82 deaths; during the same quarter of 1856 there were 96. Diarrhoea has been very prevalent amongst the inmates; there have been 69 cases of this disease; in the previous month there were 22. The diarrhoea has been of a mild form, and has not been the cause of death in any case. Other acute diseases have been rare, and the health of the inmates on the whole has been good. The weekly average number of inmates during the month has been 1394. Temperature and Meteorology of the Month.—The average temperature of the first week was being 3.9° above the average; of the second week 5.6°, which is 1.8° below the average; of the third 67.3°, which is 6.9° above; and of the fourth 60'3°, which is 1° above the average. Of the twenty-eight days, eighteen were warmer and ten colder than usual. The highest temperature registered at Greenwich in the shade was 88.5° on the 27th of the month; the lowest was 38.8° on the 14th of the month. The greatest range of temperature in the 24 hours was on the 27th, being 35°, from 53.5° to 88.5°. During the month two inches of rain have fallen at Greenwich; in May little more than half an inch. REVIEW OF THE SPRING QUARTER. During the thirteen weeks ending June 27th, 1857, there were registered in the Parish of St. Pancras 933 deaths; in the Winter quarter of this year there were 1112. During the Spring quarter of 1856, 925 deaths were registered, whilst the average for this quarter in ten preceding years is 939, which becomes when raised for the increase of population, 1033. So that the mortality of the late quarter is a little above the corresponding quarter of 1856, but about ten per cent. below the average of ten years. Of six epidemic diseases—from measles and hooping cough there have been considerably more deaths than last year; from scarlatina and diarrhoea severally one more death; from small pox one fewer, and from low fevers 17 fewer, deaths. The average temperature of the quarter has been rather above the average of the corresponding quarter of late years. By comparing the third quarterly table of this Report with the corresponding table for the Winter quarter contained in my Monthly Report, No. 13, it will be seen that there has been amongst the poor considerably less sickness during the last quarter than during the one preceding it. Instead of 1954 new cases coming under the care of the District Surgeons there were 1504; instead of 37 cases of low fever only 23; of scarlet fever, instead of 32 only 22; of small pox 10 instead of 18; of pulmonary affections 147 instead of 198. There has, however, been an increase in the numbers of measles and hooping cough, and still more of diarrhoea, as is usually the case with the advance of summer. Sanitary Works.—112 notices have been served for the improvement chiefly of house property; of these 57 have been complied with, 16 are now in progress, and 39 are as yet disregarded. All the cowsheds have been thoroughly 3 inspected, measured, and fully reported on. The notices ordered by the V estry at their last meeting have all been served on the Dairymen. In addition to this, many houses, the seats of epidemic disease, have been visited. 10 cases have been taken before a Magistrate, who ordered the necessary works of drainage. One man was taken to Clerkenwell for emptying a cesspool in the day time, and without using any deodorising materials, fined in costs, and cautioned that he was liable to 30 days imprisonment. REMOVAL OF DUST. Scarcely a day passes without complaints being received in reference to the difficulty in obtaining the removal of dust from dwelling houses. In some instances the complaint is that the dust-man does not come near the house, and cannot be found; in others, that although he comes near he will not remove the dust unless he be paid for so doing. This is a matter to which I have already referred on more than one occasion, but unfortunately the evil appears to increase rather than to diminish. It is really an evil affecting the health of the community, and not a mere matter of convenience. The ash-pit or dust-bin is used to receive almost every sort of domestic refuse, and its contents, especially in summer, undergo decomposition and give rise to most noxious, as well as offensive, effluvia. When the dust-bin is not well constructed and without a cover, as is too often the case, the evolution of these gases is much increased. By the contract entered into with the Vestry by the several contractors for the removal of dust, it is especially provided that every street in the Parish shall be visited by the dust-man at least once a week, and he is bound to remove all the refuse from any house on the request of the occupier, and is forbidden under a penalty to demand any fee for so doing; moreover, he is required to wear a badge with a number on it, so that he may be readily identified. These provisions are very good in themselves, but they are systematically set at nought in some parts of the Parish. It is the poor who especially suffer, because they cannot afford to pay the sum required for the removal of the dust, and they have but a very imperfect notion of the means by which they can obtain redress, or even effect their object. There is some difficulty in fixing the offences above-mentioned upon the guilty individuals, partly on account of the men omitting to wear their badges, and partly from the unwillingness of complainants to do anything more specific than make a general charge, without going to the trouble of identifying the man and reporting his number or name at the office. There have, however, been recently two or three cases in which the offenders have been detected, and their names are in the possession of the Chief Surveyor. It is to be hoped that the Committee of Works will not allow these cases to pass unnoticed. There are several points in reference to this matter, on which it would be useful that the Public should be instructed, and I believe that considerable benefit would arise from the distribution of notices with this object through tho Parish. In the first place they should be told that the dust-man is bound to remove the dust from their houses on being requested to do so, and that he i-s not entitled to any fee or reward for so doing. They should be urged to report all cases, in which the dust-man fails to do his duty, to the Office, in Edward Street, ascertaining the number on the badge of the man who is culpable. Further, they might be told that it lies to some extent in their own power to 4 prevent the dust-heap becoming so great a nuisance as it is in some cases, by caution in regard to the matters which they place upon it. Many of the things which are put on the dust-heap would be much better put on the fire; there would no doubt be thus produced in some cases an offensive smell, but it would be of very short duration, and would be much less injurious than the smells arising from the slow decomposition of the dust heap. I should recommend that all those, whose business it is to look to the scavenging of the Parish, should be instructed to observe carefully the dustmen from time to time, as occasion offers, to discover those who do not wear the badge. It would probably be useful if some arrangement could be made, by which certain districts should be visited on fixed days of the week, which should be made public, so that the inhabitants might know when to expect the cart, and be prepared for it. REPORT ON THE IMPERIAL GAS WORKS. My attention has been directed at intervals for twelve months past to the nuisance arising in the manufacture of Gas, at the "Works of the Imperial Company, King's Cross. In order to judge fairly on the matter, I have visited, in company with other Officers of Health, the chief Gas Works in the Metropolis, and have visited the King's Cross Works five or six times; and thus I have been enabled to compare the processes as conducted at King's Cross with those at other Gas Works. When I visited these works some twelve months ago, I found that there were several very serious grounds for complaint. In the first place the refuse from the wet lime purifiers was deposited in uncovered tanks, and gave rise to the escape of a very large quantity of sulphuretted hydrogen, sulphide of ammonium, and other most offensive and noxious gases. These tanks were a constant source of nuisance, and at frequent intervals they were emptied, and were then in. the highest degree offensive. In the next place the refuse lime charged with sulphides, was used to lute the mouths of the furnaces, and was a source of great nuisance from the same cause. Besides this was the minor nuisance arising from the oxide of iron, which had been employed for purifying the gas. The chief gas that escapes during the exposure of this product to the air is ammonia. There was also considerable annoyance arising from the smoke of the retort houses. The first ground of complaint has been partially removed, in compliance with my suggestion, by covering in the tanks used for the refuse lime. There is still however a very great nuisance occasioned every time that the tanks are disturbed, and especially when they are emptied. There are several methods in which this might be obviated. One is by the employment of oxide of iron to separate all the sulphides; and the lime which is then used subsequently, to remove carbonic acid, would be almost entirely free from odour when removed from the purifiers. Another plan is to receive the refuse lime into a close tank, and then to make hot air from the furnaces pass beneath, and play over the surface of it, on its passage to the chimney ; by this means all volatile gases are removed, and the refuse brought to a plastery consistence, and is then fit for luting. There is an objection to this method on the following ground: the injurious qualities of the gases which are thus carried up the chimney, are not completely if at all destroyed,—the gases are no doubt diffused; but there is in my mind but little doubt, that in some conditions of the atmosphere, they would descend and prove both offensive and injurious in places at some distance from the works. This plan is however adopted at the Phoenix Works (Vauxhall), 5 and is said to answer very well. The engineer of the Imperial "Works informs me that he tried it at some works on Bow Common, but was obliged to discontinue it on account of complaints from persons living at a mile distant. Another remedy for this nuisance would be the use of water-tight receptacles, which should be sent into the country without being unloaded; properly constructed barges might be thus employed. The Engineer of the Company assures me that it is the intention of the Company, as quickly as they can get their new works into operation and adjust their present apparatus, to adopt the first of the remedies mentioned above, and he authorises me to state that within twelve months this shall be the method adopted with all their manufacture. He has further promised to discontinue the nuisance arising from the employment of the refuse lime for luting, until the Company have made arrangements for separating all the sulphides from their gas by means of the oxide of iron alone; and then as I explained before the lime is almost free from objection. Arrangements are also being made for a more complete removal of ammonia from the gas before its passage through the oxide of iron purifier, by means of a large quantity of water, and thus there will be less nuisance produced during the revivification of the oxide. This nuisance might be still further diminished by the passage of air through the oxide into the chimney, as in the ease of the refuse lime. This arrangement has been adopted at the Equitable "Works, Pimlico, and the Chartered, Horseferry Road. The annoyance from the smoke of the furnaces remains unabated, and it is not easy to suggest a remedy. The general management of the premises in point of cleanliness, as far as I could judge from comparing it with the works of other companies is tolerable, although I have certainly found the place at times in a very disorderly state; this has been in part due to the alterations which are going on by new buildings. It is somewhat to be regretted that the company are just now about to increase the extent of their operations by the building of a new retort house. If this be allowed it is more than ever important that they should make use of all available means for the prevention of nuisance; but even when these are used the manufacture of gas is still a process which is offensive and injurious to health. Recently in the works of this company at Fulham they have been compelled by legal proceedings to discontinue the use of one large retort house, which had been built within a few years, in consequence of the nuisance caused to the owners of some adjacent property. It may perhaps be subject for consideration whether any steps shall be taken by the Vestry to prevent the use of the new building now in process of erection. I remain, Gentlemen, Tour obedient Servant, TH0mAS HILLIER, H.D., L.R.C.P. 21, Upper gower Street. [ SCHEDULE A. ] St. Pancras, Middlesex.—Table for the Four Weeks ending the 27th day of June, 1857. LOCALITIES. Area in Acres. Population in 1851. Births. Deaths From all causes. From all causes under 5 years of age. From Small Pox. From Measles. From Scarlatina. From Hooping Cough. From Diarrhoea. Froui Low Fever. M. F. M.&F. M. F. M.&F. Regent's Park 427 31918 33 35 68 16 20 36 13 • • 2 2 2 2 2 Tottenham Cour 27813 31 27 58 16 21 37 16 • • • • . . 4 2 3 University College Hospital 145 500 10 5 15 1 Strand Union 120 • • 5 5 Gray's Inn Road 155 26462 38 35 73 22 7 29 12 • • 1 • • 2 • • 1 Royal Free Hospital 60 4 1 5 1 Somers Town 184 35641 43 43 86 19 13 32 23 1 3 1 3 2 Camden Town 171 19515 27 33 60 20 18 38 15 .. 1 .. 4 St. Pancras Workhouse 1600 14 12 26 5 • • 1 Kentish Town 1634 23326 45 36 81 19 24 43 17 • • 1 • • • • • • 1 Middlesex and Fever Hospitals (out of the Parish 2 2 Totals 217 209 426 142 126 268 103 1 8 3 15 6 8 [ SCHEDULE B. ] Deaths Registered in Saint Pancras during 4 Weeks ending June 27th, 1857. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. I. Zymotic : Small Pox 1 1 Peritonitis 2 2 Measles 9 9 Ascites Scarlatina 3 3 Ulceration of Intestines Hernia (Rupture) 1 I Hooping Cough 13 13 croup 4 4 Ileus 1 .. .. 1 Thrus 1 1 Intussusception Diarrhœa 7 5 1 1 Stricture of Intestinal Canal Dysentery Cholera Disease of Stomach, &c. 1 .. .. 1 Influenza Disease of Pancreas Scurvy and Purpura Inflammation of Liver (Hepatitis) Ague Jaundice 2 .. .. .. .. 2 Remittent Fever Disease of Liver 2 .. 1 1 Infantile Fever Disease of Spleen 1 1 Typhus Fever 7 2 2 1 2 Puerperal Fever (Metria) VIII. Kidney, &c. ; Rheumatic Fever Erysipelas Syphilis 2 2 Nephria (Bright's Dis.) 3 1 .. 1 1 Noma (Canker) Ischuria 1 .. .. 1 Hydrophobia Diabetes .. Stone II. Dropsy, &c. : Cystitis Hæmorrhage Stricture of Urethra Dropsy 3 1 .. .. 2 Disease of Bladder,&c. 2 .. • • 2 Abscess 1 1 IX. Childbirth ; Ulcer Fistula Paramenia Mortification Onarian Drospy Cancer 8 1 2 2 2 1 Childbirth (see Metria) 2 1 1 Gout 1 .. 1 Disease of Uterus, &c. 1 .. 1 III. Tubercular; X, Joints, Bones, &c. Serofula 3 2 1 Rheumatism Tabes Mesenterica 4 4 Arthritis Phthisis (Consumption) 46 10 22 12 2 Disease of Joints, &c 1 .. .. .. 1 Hydrocephalus 8 7 . .. 1 IV. Brain and Nerves : XI. Skin, Cellular Tissue ; Cephalitis 3 3 Carbuncle Apoplexy 6 .. .. 2 4 Phlegmon Palsy (Paralysis) 5 .. .. 3 2 Disease of Skin, Ac. Delirium Tremens 4 1 2 1 XII. Malformations: Chorea Epilepsy 2 1 1 Tetanus Cyanosis Insanity Spina Bifida Convulsions 11 11 Other Malformations Disease of Brain, &c 10 6 1 2 1 XIII. Premature Birth and Debility 7 7 V. Heart and Blood Vessels ; XIV. Atrophy 4 3 .. .. 1 XV. Old Age 9 .. .. 1 2 6 Pericarditis XIV. Sudden Aneurism 1 .. .. .. 1 Disease of Heart, &c 11 .. 1 5 5 XVII. Violent Death: VI. Lungs and Organs of Respiration : Intemperance 1 .. .. l Privation of Food Want of Breast Milk Laryngitis 1 1 Neglect Bronchitis l5 4 2 5 3 1 Cold Pleurisy Poison 1 1 pneumonia 1?. 6 2 2 2 Burns and Scalds 5 5 Asthma Hanging Disease of Lungs 2 •• •• 1 1 Suffocation 1 .. * * * * 1 Drowning 1 1 VII. Stomach and Digestive Organs : Fractures & Contusions 6 2 1 2 1 Wounds Teething Other Violence Quinsey Causes not Specified 2 2 Gastritis Totals 266 128 42 49 37 10 SCHEDULE C. St. Pancras, Middlesex.—New Cases of Sickness coming under the care of the Parochial Medical Officers during the Four Weeks ending the 27th of June, 1857. Districts. Names of Medical Officers. Total No. of Cases. Low Fever Diarrhoea. Influenza. Scarlet Fever. Small Pox. Erysipelas. Puerperal Fever. Measles. Hooping Cough. Bronchitis, Pleurisy, and Pneumonia. Ague. Carbuncles and Boils. Rheumatic Fever. Other Diseases. North-West Mr. Adams 81 1 1 •• •• •• 1 .. 4 •• •• •• 2 •• 72 South-West Dr. wildbore 134 .. 13 •• 1 •• 1 •• 16 • • 6 .. .. • • 97 South-East Dr. Davis 81 .. 12 •• 2 6 2 •• 4 • • .. 2 •• .. 53 Central Mr. Sutherin 77 .. 9 •• .. 2 .. •• 1 1 6 • • .. • • 58 North Mr. Jefferys 91 4 9 •• .. • • 1 2 .. .. .. • • • • 75 Workhouse Mr. Coster 132 1 69 •• •• •• 7 3 2 13 •• 1 1 35 Totals 596 6 113 •• 3 8 12 •• 30 3 25 2 3 1 390 Table (No. I.) for Spring Quarter, 1857 St. Pancras, Middlesex—Table for the Thirteen Weeks ending the 27th day of June, 1857 LOCALITIES. Area in Acres. Population in 1851. Births, Deaths From all causes. From all causes under 5 years of age. From Small Pox. From Measles. J From Scarlatina. From Hooping Cough. From Diarrhœa. From Low Fever. M. F. M.&F. M. F. M.&F. Regent's Park 427 31918 127 150 277 76 84 160 71 •• 6 8 10 3 4 Tottenham Court 145 27813 122 108 230 56 69 125 59 •• •• 1 19 2 8 University College Hospital 500 22 16 38 2 Strand Union 120 11 24 35 2 .. 1 .. .. 1 Gray's Inn Road 155 26462 122 99 221 58 50 108 44 3 1 6 1 2 Royal Free Hospital 60 8 6 14 1 •• •• •• •• 1 1 4 Somers Town 184 35641 156 174 330 72 76 148 69 2 6 4 7 3 Camden Town 171 19515 88 105 193 51 40 91 38 •• 2 2 6 •• 4 St. Pancras Workhouse 1600 34 48 82 13 •• •• •• 1 •• Kentish Town 1634 23326 140 160 300 67 65 132 50 4 3 1 1 6 Middlesex and Fever Hospitals (out of the Parish 8 5 13 •• •• •• •• •• •• 1 Totals 755 796 1551 463 483 946 349 2 22 19 50 12 30 Corresponding Quarter of 1856 1522 925 369 3 14 18 40 11 47 Table (No. II) for Spring Quarter of 1857. Deaths Registered in St. Pancras during Thirteen Weeks ending June 27,1857. Causes of Death. At all Ages. Under 20 years of acre. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. I. Zymotic 172 140 13 8 10 1 Small Pox Peritonitis Measles Ascites Scarlatina Ulceration of Intestines Hooping Cough Hernia (Rupture) Croup Ileus Thrush Intussusception Diarrhœa Stricture of Intestinal Canal Dysentery Cholera Disease of Stomach, Ac. Influenza Disease of Pancreas Scurvy and Purpura Inflammation of Liver (Hepatitis) Argue Jaundice Remittent Fever Disease of Liver Infantile Fever Disease of Spleen Typhus Fever Puerperal Fever (Metria) Rheumatic Fever VIII. Kidney, &c.; 17 1 2 6 7 1 Erysipelas Nephritis Sylhilis Nephritis Noma (Canker) Ischuria Hydrophobia Diabetes Stone II. Dropsy, &c.: 60 6 8 19 24 3 Cystitis Hæmorrhage Stricture of Urethra Dropsy Disease of Bladder, &c Abscess IX. Childbirth: 7 1 4 2 Ulcer Fistula Paramenia Mortification Ovarian Cancer Childbirht (See Metria) Gout Disease of Uterus ,&c III. Tubercular; 183 67 64 45 7 X. Joints, Bones, &c. : 6 .. 1 2 3 Scrofula Rheumatism Tabes Mesenterica Arthritis Phthisis (Consumption) Disease of Joints, &c Hydrocephalus IV. Brain and Nerves : 111 45 14 20 28 4 XI. Skin, Cellular Tissue; 1 .. .. 1 Cephalitis Carbuncle Apoplexy Phlegmon Palsy (paralysis) Disease of Skin ,&c. Delirium Tremens XII. Malformations: 2 2 Chorea Epilepsy Cyanosis Tetanus Spina Bifild Insanity Other Malformations Convulsions Disease of Brain, &c XIII. Premature Birth and Debility 24 24 V. Heart and Blood Vessels : 36 2 3 17 14 XIV. Atrophy 22 20 .. .. 2, XV. Old Age 62 .. .. 2 32 28 Pericarditis XVI. Sudden Aneurism - Disease of Heart, &c XVII. Violent Death: 30 18 4 5 3 Intemperance VI. Lungs and Organs of Respiration : 157 73 10 36 31 7 Privation of Food Want of Breast Milk Laryngitis Neglect Bronchitis Cold Pleurisy poison Pneumonia Burns and Scalds Asthma Hanging Disease of Lungs Suffocation Drowning VII. Stomach and Digestive Organs: 39 16 2 13 5 3 Fractures & Contusions Wounds Other Violence Teething Causes not Specified 4 3 1 Quinsey Gastritis Totals 933 418 126 176 166 47 Table (No. III) for Spring Quarter of 1857. St. Pancras, Middlesex.— Cases of Sickness under the care of the Parochial Medical Officers during the Thirteen Weeks ending the 27th of June, 1857. Districts. Names of Medical Officers. Total No. of Cases. Low Fevers. Diarrhoea. Influenza. i Scarlet Fever. Small Pox. Erysipelas. Puerperal Fever. 1 Measles. Hooping Cough. 1 Bronchitis, Pleurisy, and Pneumonia. Ague. Carbuncles and Boils. Rheumatic Fever. Other Diseases. North-West Mr. Adams 258 1 4 .. 7 .. 1 .. 10 2 23 .. 4 .. 196 South-West Dr. WiLDBORE 414 4 13 •• 6 .. 2 •• 38 8 50 •• • • .. 302 South-East Dr. Davis 302 3 29 •• 8 6 6 • • 5 6 23 •• 1 1 214 Central Mr. Sutherin 252 5 21 •• 1 3 1 1 10 12 26 •• • • 2 170 North Mr. Jefferys 278 10 14 •• .. .. 2 • • 7 1 26 •• • • .. 219 Workhouse Mr. Coster 341 1 92 •• •• •• 13 •• 3 12 51 •• 3 5 161 Totals 1845 24 173 •• 22 10 25 1 73 41 198 8 8 1262 ' \ <_* ■ . REPORT on the SANITARY CONDITION OF SAINT PANCRAS, MIDDLESEX, DURING JULY 1857, by THOMAS HILLIER, M.D., Medical Officer of Health for the Parish of Saint Pancras. August 11th, 1857.] [No. 16. TO THE SANITAKY COMMITTEE. Gentlemen— In the five weeks that ended on Saturday, August 1st, there were registered in this Parish 380 deaths. Of these, 92 were registered in the first week, 63 in the second, 50 in the third, 79 in the fourth, and 96 in the fifth week. The average number of deaths in the corresponding weeks of the ten years 1847-56, was 346; this number becomes, when allowance is made for the increase of population, 381; so that the present return gives a number very near to the corrected average of the ten years. The mortality recorded this month exhibits, however, a very decided increase on that of last month; in the four weeks of June the weekly average was 66 5, whilst in the late five weeks the average was 76. The increase is chiefly due to the prevalence of diarrhoea, which has, together with English cholera, been fatal to 58 persons. Of this number, 46 were children under 1 year of age, 7 between 1 and 2 years, 2 between 2 and 3 years, and 3 were persons over 60 years of age. During the fourth and fifth weeks severally, 20 deaths have occurred from diarrhoea. These numbers show a mortality from diarrhoea very much in excess of what is usual during the month of July. Last year, instead of 58, there were only 20 in the five corresponding weeks. It is generally the case that a very high temperature gives rise in London to diarrhcea, which proves very fatal to young children. It was so last year during August, which was the hottest month, and during the late month the temperature has been considerably above the average. The average temperature during 43 preceding years was 61.7°, whilst this year it has been 64.7°. Of the 35 days only 9 have been cooler than usual, whilst on the 28th June the temperature was 12.4Q above; on the loth Judy, 11°; on the 23rd and 24th more than 9°; and on the 31st, 8.3° above the average of previous years. It is to the young that the heat proves especially fatal, as may be seen by observing the following statements. Of the total number of deaths exactly one half were of children under 5 years, and more than one-third under one year of age. During the months of April, May, and June of this year, children under 5 years of age died at about the rate of nearly 27 per week; during the last 2 five weeks at the rate of 38 per week; whilst older persons died in the three months mentioned at a weekly rate of 45, and during the last five weeks only at the rate of 38. Above the age of 60, persons died in the three Spring months at a weekly rate of 17, and in July at a rate of only 11. One probable cause of the very young suffering more than the older from hot weather is, that they are confined very much to the house, and are thus subjected without intermission to the evils of defective ventilation and foul drainage, from which the other members of the family may escape for some hours during the day. But, in addition to this, it must be remembered that attacks which would only lay aside adults for a few days are sufficient to destroy the lives of delicate infants; and although deaths of adults from diarrhoea have been rare, yet the disease has been very prevalent in persons of all ages. Of other zymotic diseases, hooping cough caused 13 deaths, scarlatina and malignant sore throat 11, low fever 10 (or including one death in the Fever Hospital 11), measles 4, and small pox 3. During the month small pox has been very extensively prevalent in Somers Town (more than 50 cases having come to my knowledge); but happily it has proved fatal in only three instances, and these were persons not vaccinated. Notices have been issued during the month advising the inhabitants what means should be adopted to check the spread of the disease, and it is believed that thoy have proved very useful. Before the introduction of vaccination small pox was fatal to about a third of all those attacked, whilst it fearfully mutilated or permanently impaired the health of those who were not destroyed. At the present time, where vaccination has been properly performed, it is very rare to see small pox occur, and still more so to cause death, or even permanent disfigurement or impairment of health. It is not perhaps too much to hope, that if vaccination were universal, the disease would, in the coursc of years, become quite unknown. During July, there were sent from this parish to the Fever Hospital seven persons suffering from typhus fever; they were all members of one family, and occupied a small ill-ventilated house in Brill-place. The disease appears to have been imported by a woman living in Islington parish; its development was very much promoted by the closeness of the house, and the dirty habits of the inmates. The house has been entirely evacuated, and thoroughly cleansed, and the means of ventilation improved. In accordance with your instructions, a man in Prince of "Wales's Court, Hampstead Road, was summoned to the Police Court for overcrowding a house containing two small rooms each, 12 feet square and about feet high. There were 5 adults in each room, members of different families, and in the lower room there were two dogs and forty or fifty baskets of fruit and vegetables. The house was not provided with any privy or water-closet. The Magistrate inflicted a fine on the man of 40s., or in default a month's imprisonment. Amongst the deaths registered in this Report are seven of persons killed by the falling of three houses in Tottenham-court-road, the account of which is probably fresh in the memory of all. One man died in the "Workhouse of inflammation of the lungs, which is said to have been caused by the inhalation of gases from the soil of a gas works at Greenwich, where he was working at the construction of a wharf frontage. As I mentioned last month, the refuse products obtained in the manufacture of gas gives rise to most offensive and noxious emanations, and the very utmost care should be enforced to reduce these effects to a minimum. There is not sufficient caution used to prevent the saturation of the soil with the soakings from these products, and thus even the surface water which comes from gas works is very offensive, and gives rise to a large quantity of noxious gases. On Saturday last, a butcher, named Collins, was fined £5 at the Clerkenwell Police Court for continuing to kill in an area not licensed as a slaughterhouse, after repeated warnings by the Inspector of Nuisances. 3 There can be no doubt that very much diarrhoea is occasioned during hot weather by the use of unwholesome food, especially unripe and rotten fruit, and putrid fish and meat. If the Inspector's time were not fully occupied, much more might be done to check the sale of some of these things. At the present season attention to complaints alone is more than enough to engage our notice, and many important matters are obliged to be neglected. The time is approaching for a renewed inspection of the slaughter houses with reference to the re-application for licenses; and the time has now expired which was allowed to the Dairymen to improve the state of their cowsheds, so that the sheds should be again inspected to ascertain how far the notices have been of use, and, if necessary, to enforce the requisite improvements by an appeal to a Magistrate. Workhouse.—During the five weeks there have been 36 deaths in this establishment. There have been none from epidemic disease. Diarrhoea of a mild form has been very prevalent; 124 persons have been treated for this disorder. The number of deaths and of cases of illness is higher than usual. The Surgeons, however, report favorably of the general state of the health of the House, with the exception of diarrhoea. The average number of inmates has been 1323. Meteorology.—The average temperature of the first week was 62.4°, which is 1° above the average; of the second, 59.6°, which is 2° below; of the third, 68°, which is 6.3° above; of the fourth, 68.3°, which is 6.7° above; and of the fifth, 65.6°, which is 3.2° above, the several averages of corresponding weeks in 43 preceding years. The highest temperature in the shade at Greenwioh was on the 28th June, 92.7°; the lowest was on the 8th July, 45.7°. The greatest range of temperature in 24 hours was on the 28th June, from 55.3° to 92.7°, being 37.4°. At Greenwich l.36 inches of rain fell during the whole period. The electricity of the five weeks has been for the most part nearly positive; on the 10th and 24th only was it negative, and on several days the electrometer gave no indication. I remain, Gentlemen, Tour obedient Servant, THOMAS HILLIER, M.D., L.R.C.P. 21, Upper Gower Street. * This column includes Four Cases of "Cholera Infantum." [ SCHEDULE A. ] St. Pancras, Middlesex.—Table for the Five Weeks ending the 1st day of August, 1857. LOCALITIES. Area in Acres. Population in 1851. Births. Deaths From all causes. From all causes under 5 years of age. From Small Pox. From Measles. From Scarlatina. From Hooping Cough. From Diarrhoea.* From Low Fever. M. F. M.&F. M. F. M.&F. Regent's Park 427 31918 70 48 118 21 31 52 24 .. .. 2 1 10 1 Tottenham Court 145 27813 42 33 75 39 23 62 32 .. .. 1 5 10 4 University College Hospital 500 7 2 9 1 Strand Union 120 5 5 10 4 .. .. .. .. 1 Gray's Inn Road 155 26462 31 39 70 23 18 41 30 .. 1 •• •• 14 2 Royal Free Hospital 60 1 •• 1 Somers Town 184 35641 66 68 134 42 37 79 41 3 3 3 2 8 1 Camden Town 171 19515 47 47 94 9 31 40 20 .. .. .. 2 5 St. Pancras Workhouse 1600 20 16 36 4 Kentish Town 1634 23326 62 60 122 23 27 50 30 • • •• 5 3 10 2 Middlesex and Fever Hospitals (out of the Parish) 2 .. 2 .. .. .. .. .. .. 1 Totals 318 295 613 192 190 382 190 3 4 11 13 58 11 [ SCHEDULE B. ] Deaths Registered in St. Pancras during Five Weeks ending August 1st, 1857. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. [/###/At 80 years of age and upwards. I. Zymotic : Enteritis 1 1 Small Pox 3 3 Peritonitis 1 .. 1 Measles 4 4 Ascites 2 .. 1 1 Scarlatina 11 11 Uleerattion of intestines Hooping Cough 13 13 Hernia(Rupture) Croup 4 4 Ileus 3 2 .. 1 Thrush 4 4 Intussuseeption 1 .. .. 1 Diarrhœa Dysentery 54 51 .. .. 3 Canal Cholera 4 4 Disease of stomach,&c. Influnza Disease of pancreas Scurvy and Purpura Inflammation of Liver (Hepatitis) Ague Jaundice 4 1 1 1 1 Remittent Fever Dissease of lliver 4 .. .. 3 1 Infantile Fever 1 1 Dissease of spleen Typhus Fever 10 3 4 2 1 1 1 Rheumatic Fever 1 1 VIII. Kidney, &c. ; Erysipelas 3 1 .. 2 Nephritis 2 .. .. 2 Syphilis 2 I I Nephria (Bright's dis) 4 .. 1 2 1 Noma(canker) Ischuria Hydrophobia Diabetes 1 .. 1 II. Drop3Y, &c. : Stone Cystitis 1 1 Stricture of Urethra Dropsy 2 • • • • 1 1 Disease of bladder,&c. Abscess Ix. childbirth Ulcer 1 1 Fistula 1 .. .. .. 1 Paramenia Mortification Ovarian Dropsy 1 .. .. 1 Cancer 8 .. 1 5 2 Childbirth(see martia) 4 .. 4 Gcut 3 .. 2 1 Disease of uterus,&c. III. Tubercular; X, Joints, Bones, &c. : Scrofula 3 2 1 Rheumatism Tabes Mesenterica Phthisis (Consumption) 10 55 10 7 24 19 5 Arthritis Disease of Joints, &c Hydrocephalus 7 7 IV. Brain and Nerves : XI. Skin, Cellular Tissue ; 6 3 1 2 Carbuncle Apoplexy 4 1 .. 2 1 Phlegmon Palsy 3 .. .. .. 2 1 Disease ofskin,&c. 1 Delirium Tremens Chorea XII. Malformations: Epilepsy 2 1 .. 1 Cyanosis Tetanus Insanity 1 1 Spina Bifida convulsions 9 9 Other Malfolations 1 1 Disease of Brain, &c 11 8 2 .. .. 1 XIII. premature birth and debility 9 9 V, Heart and Blood Vessels : XIV. Atrophy 29 29 Pericardities XV. old age 17 .. .. .. 7 10 Aneurism 2 .. .. 1 1 XVI. Sudden Disease of Heart, &c. VI. Lungs and Organs of Respiration : 8 1 1 1 5 XVII. Violent Death: Intemperance Privation of Food , Want of Breast Milk Neglect 2 2 Bronchities 14 7 .. 2 4 1 Cold Pleurisy Poison Pneumonia 5 5 Burns and scalds Asthma 2 .. .. .. 2 hanging 1 .. .. .. 1 Disease of Lungs 2, 1 .. .. 1 Suffocation 2 1 .. 1 VII. Stomach and Digestive Organs; Drowning Fractures & Contusions 4 .. 1 1 2 Teething 1 1 Other Violence 7 1 6 Quinsey Cause not specified 3 3 Gastritis Totals 380 217 52 53 45 13 [ SCHEDULE C. ] St. Pancras, Middlesex.—New Cases of Sickness coming under the care of the Parochial Medical Officers during the Five Weeks ending the 1st of August, 1857. Districts. Names of Medical Officers. Total No. of Cases. Low Fevers. Diarrhoea. Influenza. Scarlet Fever. Small Pox. Erysipelas. Puerperal Fever. Measles. Hooping Cough. Bronchitis, Pleurisy, and Pneumonia. Ague. Carbuncles and Boils. Rheumatic Fever. Other Diseases. North-West Mr. Adams 140 1 29 .. 5 .. 1 .. 2 4 .. .. .. .. 98 South-West Dr. WlLDBORE 209 6 59 .. 1 .. 1 .. 8 3 3 •• .. 1 127 South-East Dr. Davis 189 .. 64 .. • • 8 2 .. 7 1 •• 1 .. •• 106 Central Mr. Sdtherin 138 12 25 .. • • 6 •• .. 3 2 6 •• .. •• 84 North Mr. Jefferys 120 3 40 .. .. 2 1 2 .. 1 .. 2 69 Workhouse and Infirmary Mr. Coster and Mr. Andrews 22G •• 124 .. •• •• 1 .. •• •• 15 •• .. 3 83 Totals 1022 22 341 .. 6 16 6 •• 22 10 25 1 .. 6 567 REPORT on the SANITARY CONDITION OF SAINT PANCRAS, MIDDLESEX, DURING AUGUST AND SEPTEMBER, 1857, by THOMAS HILLIER, M.D. Medical Officer of Health for the Parish of Saint Pancras. October 13th, 1857.] [Nos. 17 & 18. TO THE SANITARY COMMITTEE. Gentlemen, In the eight weeks that ended September 26th there were registered in this parish 585 deaths, giving a weekly average mortality of 73. The average of the corresponding weeks in the ten years, 1847-1856, was 649, giving a weekly average of 81. So that the recent months of August and September show a mortality one-tenth lower than the average of the ten preceding years. But it must be remembered that these ten years comprise the autumns of 1849 and 1854, in which cholera prevailed. The deaths have been registered as follows : in the first week, 93; in the second, 74; in the third, 72; in the fourth, 74; in the fifth, 57; in the sixth, 77; in the seventh, 57; in the eighth, 81. It will be seen from these numbers that during the month of September the mortality has been much lower than during the month of August. From diarrhoea and infantile cholera there have been 76 deaths, distributed over the eight weeks as follows : in the first week, 18 ; in the second, 20; in the third, 8 ; in the fourth, 7 ; in the fifth, 4 ; in the sixth, 12; in the seventh, 4; in the eighth, 3. So that the mortality from diarrhoea has much decreased since August. This is usually the case as the weather becomes cooler. The deaths from diarrhoea have been, with six exceptions, those of quite young children. I am happy to report that since the end of July there have been no deaths from Small Pox. During the two months 10 cases have been sent to the Small Pox Hospital. The threatened outbreak of this disease in the crowded streets of Somers Town has been, I believe, in great measure, checked by the precautionary notices issued under your direction. Low fevers are at present slightly on the increase; daring August 8 deaths were registered under this head, and in September 15. Under the age of fire years there have been 272 deaths, giving an average weekly mortality of 34 at this age ; whilst in July last the rate was 38 per week, and in the spring months only 27. WORKHOUSE. In the four weeks of August there were 23 deaths in this building, and in September 21. Of the whole number one was from hooping cough and one from diarrhoea. Nearly all the other deaths have been from chronic diseases. The number of cases of diarrhoea has decreased from 124 in five weeks of July, to 24 in the four weeks of August, and 5 in the four weeks of September. The weekly average number of inmates in August was 1,376, and in September 1,433; whilst in July it was only 1,323; so that the numbers are now steadily on the increase. 2 Meteorology.—The mean temperature of the late two months has been in each week above the average, 63° as compared with 59.3. The excess of temperature was greatest in the fourth week, when there was a difference of 6.2° from the average of ten years. The highest temperature noted in the shade at Greenwich was 88°, on the 3rd of August; and the lowest was 46.9°, on the 3rd of September. The highest temperature in September was on the 17th, when it was 80.7° About 6½ inches of rain have fallen during the eight weeks, of which 3¾ fell in August. Although diarrhoea is somewhat on the decline at present, yet there are several circumstances which cannot fail to be regarded very seriously, and to excite apprehensions that at no distant period our country will be again invaded with that fearful epidemic, the Cholera. The circumstances referred to are these : Cholera is at the present time raging at several of the Baltic ports and at Hamburgh. In each of the three previous epidemics the existence of cholera in the last named place has been speedily followed by its appearance in the eastern seaports of this country. During the last quarter there has been an unusually high mortality from diarrhoea, no less than 2,343 persons having died from this disease in London, which is a number very much greater than the number of those who died in the corresponding quarters of 1855 and 1856. An increased prevalence of this disease has in each case preceded the epidemic of cholera. There have been isolated cases of genuine cholera occurring at intervals during the late summer, another circumstanco always observed before the invasions of this pestilence. So recently as Saturday last a woman, a vagrant, admitted a few days previously to the separation ward of the workhouse, died in three hours from an attack closely resembling Asiatic cholera. "Whether we are about to be again visited with cholera or not, there can bo no question as to the wisdom of at once adopting such measures as would in case of its appearance render it comparatively harmless. Very much has been done in this direction since the commencement of last year; but in comparison with what remains unaccomplished it is but as nothing. House-to-house visitation is urgently required in very many places, to see that the houses be well drained, supplied with water, not over-crowded, and sufficiently ventilated, and that proper provision is made for the removal of refuse. More than one man's time is however required to inspect slaughter-houses, cow-houses, and offensive trades, and to investigate the nuisances complained of on private premises and public ways. Then each week there are a large number of houses that ought to be visited, in which epidemic sickness has existed. Almost always when a house of this kind is visited by myself, evils are discovered, the remedying of which entails several additional visits, besides the filling up and serving of notices. Much time too is often taken in determining who is the responsible party. In the cases where the preliminary notice is disregarded, it is requisite to obtain a summons from the police magistrate at one of four police courts, according to the district in which the nuisance exists, and the case has to be heard on some future day, the greater part of which is thus engaged. It is quite impossible with one inspector, to institute such inquiries as are in my opinion imperatively called for during the ensuing winter. I have felt it to be my duty to make to you this statement, because I am fully convinced that both your duty, as guardians of the public health, and your policy, as holders of the public purse, equally point towards the adoption of such a course as I have indicated. I have the honour to remain, Gentlemen, Your obedient Servant, 21, Upper Gower Street. THOMAS HILLIER, M.D., L.R.C.P. * Whilst this Report is in the Press, I have received information of an outbreak of Asiatic Cholera at West Ham, near Stratford. There have already been 15 cases of the disease since the 1st of October, of which 7 have been fatal. * This column includes Two Cases registered " Cholera Infantum " and one " Dysentery." [ SCHEDULE A. ] St. Pancras, Middlesex—Table for the Four Weeks ending the 29th day of August, 1857. LOCALITIES. Area in Acres. Population in 1851. Births. Deaths From all causes. From all causes under 5 years of age. From Small Pox. From Measles. From Scarlatina. From Hooping Cough. From Diarrhoea.* From Low Fever. M. F. M.&F. M. F. M.&F. Regent's Park 427 31918 37 32 69 7 23 30 19 .. 2 .. 9 Tottenham Court 145 27813 39 26 65 25 26 51 26 .. 1 1 4 11 i University College Hospital 500 10 2 12 Strand Union 120 2 4 6 Gray's Inn Road 155 26462 32 29 61 23 22 45 22 .. 2 .. .. 9 1 Royal Free Hospital 60 4 3 7 .. .. .. .. .. .. 1 Somers Town 184 35641 42 43 85 23 28 51 27 .. 3 3 1 9 2 Camden Town 171 19515 35 34 69 21 24 45 23 .. 2 2 2 2 St. Pancras Workhouse 1600 13 10 23 2 .. .. .. .. 1 Kentish Town 1634 23326 34 45 79 21 22 43 22 .. .. .. .. 13 3 Middlesex and Fever Hospitals (out of the Parish) 1 •• 1 Totals 219 209 428 150 164 314 141 •• 8 8 7 54 8 [ SCHEDULE B. ] Deaths Registered in St. Pancras during Four Weeks ending August 29th, 1857. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. Causes of Death. At all Ages. Under 20 years ot age. At 20 and under 40 I years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. I. Zymotic : Enteritis Peritonitis 1 1 Ascites 2 2 q 9 Ulceration of Intestines 7 7 Hernia (Kupture) 3 3 Ileus 1 1 3 51 Intussusception 46 1 Stricture of Intestinal Canal 2 Disease o fStomach, &c. 1 1 Disease of Pancreas Scurvy and Purpura Inflammation of Liver (Hepatitis) 1 1 1 1 Disease of Liver 6 2 3 1 Typhus Fever 7 4 1 2 Disease of Spleen Puerperal Fever (Metria) Rheumatic Fever 1 •• 1 VIII. Kidney, &c. ; Erysipelas 2 1 1 Syphilis 2 2 2 1 1 Noma (Canker) Hydrophobia Diabetes II. Dropsy, &c. : Stricture of Urethra Dropsy 2 1 1 Disease of Bladder, &c. 1 1 Abscess 2 1 1 IX. Childbirth : 1 1 7 .. 2 1 4 Childbirth (see Metria) 2 2 Gout 2 •• L •• 1 Disease of Uterus, &c. III. Tubercular; X. Joints, Bones, &c. : Scrofula 1 1 Rheumatism 2 1 1 Tabes Mesenterica .. 6 6 Phthisis (Consumption) 40 6 22 11 1 Disease of Joints, &c 2 1 .. 1 Hydrocephalus IV. Brain and Nerves : 8 8 XI. Skin, Cellular Tissue ; Cephalitis 5 5 Carbuncle 1 1 Apoplexy 11 2 1 2 5 1 6 • • 1 1 4 Disease of Skin, &c. XII. Malformations : Spina Bifida 11 10 1 Other Malformations Disease of Brain, &c 3 1 2 XIII. Premature Birth and Debility 8 8 XIV. Atrophy 9 9 XV. Old Age 20 1 11 8 1 1 XVI. Sudden 2 .. 1 .. .. 1 Disease of Heart, &c 3 1 .. 2 XVII. Violent Death: VI. Lungs and Organs of Respiration : 1 1 Privation of Food . Want of Breast Milk 8 1 1 2 4 Cold 10 5 4 1 Burns and Scalds 1 1 1 .. .. 1 Hanging 2 1 1 Disease of Lungs 3 .. 1 2 Suffocation 2 1 1 2 1 1 VII. Stomach and Fractures & Contusions 6 1 3 1 1 1 gestive Organs; Wounds 1 Other Violence Quinsey Causes not Specified 1 1 Gastritis Totals 313 164 48 43 44 14 [ SCHEDULE C. ] St. Pancras, Middlesex—New Cases of Sickness coming under the care of the Parochial Medical Officers during the Four Weeks ending the 29th of August, 1857. Districts. Names of Medical Officers. Total No. of Cases. Low Fevers. Diarrhoea. Influenza. Scarlet Fever. Small Pox. Erysipelas. Puerperal Fever. Measles. Hooping Cough. Bronchitis, Pleurisy, and Pneumonia. Ague. Carbuncles and Boils. Rheumatic Fever. Other Diseases. North-West Mr. Adams 98 2 18 .. 2 .. 1 .. .. 1 1 .. .. 73 South-West Dr. wlldbore 142 4 38 .. 1 .. 1 .. 1 3 2 .. .. 2 90 South-East Dr. Davis 153 2 48 .. 3 2 .. .. 1 .. .. .. .. 1 96 Central Mr. Sutherin 136 2 24 .. .. .. .. .. 3 1 6 .. .. 1 99 North Mr. Jefferys 131 4 29 .. 4 1 1 .. .. .. 1 .. .. .. 91 Workhouse Mr. Coster 214 2 24 .. •• •• 1 .. .. 1 11 .. .. •• 175 Totals 874 16 181 .. 10 3 4 •• 5 6 21 .. | .. 4 624 The weekly average number of inmates in the Workhouse was 1,376. * This column includes One Case registered as "Cholera Infantum" and one case as "Dysentery." [ SCHEDULE D. ] St. Pancras, Middlesex,—Table for the Four Weeks ending the 26th day of Sept., 1857. LOCALITIES. Area in Acres. Population in 1851. Births. Deaths From all causes. From all causes under 5 years of age. From Small Pox. From Measles. From Scarlatina. From Hooping Cough. From Diarrhoea.* From Low Fever. M. F. M.&F. M. F. M.&F. Regent's Park 427 31918 57 37 94 19 16 35 13 1 .. 3 Tottenham Court 145 27813 33 28 61 16 22 38 24 .. 1 2 2 6 1 University College Hospital 500 12 3 15 3 Strand Union 120 5 3 8 Gray's Inn Road 155 26462 27 36 63 17 17 34 23 .. 3 .. 2 3 2 Royal Free Hospital 60 4 1 5 .. .. .. .. .. .. 1 Somers Town 184 35641 59 37 96 28 14 42 19 .. 3 1 .. 4 4 Canden Town 171 19515 18 31 49 9 17 26 18 .. 1 .. 1 3 1 St. Pancras Workhouse 1600 10 11 21 4 .. .. .. 1 Kentish Town 1634 23326 53 43 96 29 19 48 27 .. .. .. .. 3 5 Middlesex and Fever Hospitals (out of the Parish) •• 2 2 .. .. .. .. .. .. 1 Totals 247 212 459 149 125 274 131 •• 8 4 6 22 15 [ SCHEDULE E. ] Deaths Registered in St. Pancras during Four Weeks ending Sept. 26th, 1857. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. | At 40 and under 60 years of age. At 60 and under 80 years of age.  At 80 years of ago and upwards. I. Zymotic : Enteritis 2 1 1 Peritonities 1 1 smal lpox Ascites 1 .. 1 Measles 8 8 Ulceration of Intestines 2 1 1 Scarlatina 4 4 Hernia (Kupture) 2 .. .. 1 1 Hooping Cough 6 6 Ileus 1 .. .. 1 Croup 3 3 Intussuseeption Thrush 1 I Stricture of intentional canal Diarrhoea 18 17 .. .. 1 Dysentery 1 1 Disease of Stomach, &c. 1 .. .. 1 Cholera 1 1 Disease of Pancreas Influenza Inflammation of Liver Scurvy and purpura (Hepatitis) Ague Jaundice 1 1 Remittent Fever Disease of Liver 3 .. .. 1 2 Infantile Fever 14 4 4 4 2 Disease of Spleen 1 .. 1 Puerperal Fever (Metria) 2 1 1 VIII. Kidney, &c. ; Rheumatic fever Nephritis Erysipeals 3 1 1 .. 1 Nephria (Bright's Dis.) 3 .. i 2 Syphilis 2 2 Ischuria Noma(canker) Diabeties 1 .. .. 1 Hydrophobia Stone II. Daorsv, &c. : Stricture of urethra Disease of bladder,&c. 2 .. .. .. 2 HEamorrahage 2 1 1 Dropsy 1 .. .. .. 1 Abscess 3 2 1 Ulcer IX. Childbirth : Fistula Paramenia Mortification Ovarian Dropsv Cancer 5 1 1 1 2 Childbirth (see Metria) 1 .. l Gcut Disease of Uterns, &c. III. Tubercular: X. Joints, Bones, &c. : Scrofula 3 3 Rheumatism 2 .. .. 2 Tabes Mesenterica Phthisis (Consumption) 9 9 Arthritis 34 4 20 9 1 Disease of Joints, &c 1 .. .. 1 Hydrocephalus 8 8 IV. Brain and Nerves : XI..Skin, Cellular Tissue ; cephalities Carbuncle Apoplexy 10 4 1 1 4 Phlegmon Palsy(paralysis) 7 .. .. 3 2 2 Disease of Skin, Ac. Delirium Tremens XII. Malformations : chorea Cyanosis Epilepsy Spina Bifida Tetanus Other Malformations 2 2 Insanity Tisease of Brain, &o 3 2 •• 1 XIII. Premature Birth and Debility 15 15 V. Heart and Blood XIV.Atrophy 12 12 Vessels : XV. Old age 14 .. .. 2 6 6 pericarditis XVI. Sudden Aneurism 2 .. 1 .. 1 Disease of Heart, &c 9 2 1 2 3 1 XVII. Violent Death: intemperance VI. Lungs and Organs Privation of Food of Respiration : Want of Breast Milk Neglect Laryngitis 9 4 1 4 Cold Bronchitis poison 1 1 Pleurisy Burns and Scalds 3 3 Pneumonia 4 4 Hanging 1 .. 1 Disease of Lungs 1 .. .. 1 Suffocation 2 2 Drowning 1 1 VII. Stomach and Digestive Organs; Fractures & Contusions 6 .. 3 2 .. 1 Wounds 3 .. 1 2 1 1 other violence 1 1 Teething Causes not Specified 2 .. 1 .. 1 Quinsey Gastrities Totals 272 145 44 39 34 10 [ SCHEDULE F. ] St. Pancras, Middlesex.—New Cases of Sickness coming under the care of the Parochial Medical Officers during the Four Weeks ending the 26th of September, 1857. Districts. Names of Medical Officers. Total No. of Cases. Low Fevers. Diarrhoea. Influenza. Scarlet Fever. Small Pox. Erysipelas. Puerperal Fever. Measles. Hooping Cough. Bronchitis, Pleurisy, and Pneumonia. Croup. Carbuncles and Boils. Rheumatism. Other Diseases. North-West Mr. Adams 86 3 8 .. .. .. 1 .. .. 2 6 .. .. 2 64 South-West Dr. WlLDBORE 129 5 16 .. 5 .. .. .. 10 .. 7 1 .. 1 84 South-East Dr. Davis 153 3 40 .. 1 9 .. .. 5 2 6 .. 3 .. 84 Central Mr. SCTHERIN 104 2 7 .. 1 1 .. .. 10 2 6 .. .. .. 75 North Mr. Jefferys 108 . . 16 .. .. .. 1 .. 1 2 2 .. .. 1 85 Workhouse & Infirmary Mr. Coster 136 1 5 .. •• 1 1 .. •• 3 5 •• 4 3 113 Totals 716 14 92 •• 7 11 3 .. 26 11 32 1 7 7 505 The weekly average number of inmates in the Workhouse was 1,433. REPORT on the SANITARY CONDITION OF SAINT PANCRAS, MIDDLESEX, DURING OCTOBER, 1857, by THOMAS HILLIER, M.D., Medical Officer of Health for the Parish of Saint Pancras. November 16th, 1857.] [No. 19. TO THE SANITARY COMMITTEE. Gentlemen-, During five weeks, ending October 31st, 1857, there were registered in St. Pancras 318 deaths, which shows an average weekly mortality of 63.6. In the ten years, 1847-56, the average number of deaths in the corresponding five weeks was 339.5. So that the mortality now returned is lower than that of ten previous years, even without any allowance being made for an increase in population. Zymotic diseases have been fatal to 75 persons. Measles, Scarlet Eever, and Hooping Cough have been more fatal than during the months of August and September. There have been two fatal cases of Small Pox in persons not vaccinated. Amongst the 13 cases returned by me as scarlet fever are two cases, one registered "Sore throat, fever," and the other, "Diphtherite of throat and larynx." It is doubtful whether these were cases of scarlet fever without eruption or a distinct disease, such as has recently been very fatal in Essex and some other counties. A man and two children died within a period of 84 hours of a very virulent form of scarlet fever, in Medburn Street, Somers Town. Diarrhoea has shown a considerable diminution, causing only six deaths in five weeks, instead of 18 in the previous four weeks. Diseases of the organs of respiration have as usual greatly increased with the change in the weather. In four weeks of September these diseases were only fatal to 14, whilst in the five weeks just past they were fatal to 63 persons, of whom 42 were infants under three years of age. From all diseases 147 children have died under the age of five years. There is one circumstance which renders the return for this month fallacious as an indication of the number of persons who have actually died during the month; it is this,—that the registers for this month contain the records of scarcely any deaths which have been the subjects of inquests, inasmuch as these deaths are seldom returned until nearly the end of the quarter. The effect of this is, that the first month in each quarter appears more healthy, and the last month more unhealthy, than they really are. A very lamentable illustration of the bad effects of a defect in drainage has occurred during the last month in a gentleman's house in Ampthill Square. The entrance of the drain from this house into the sewer was not furnished with a trap, and in consequence, until this circumstance was discovered, and a trap supplied, the house was for several weeks pervaded with a most foul scent of drainage. Every member of the household (15 in number) was in a depressed state of health, with disturbance of the bowels, and five cases of typhoid fever (the kind of fever which usually results from bad drainage) have occurred, of which one has already proved fatal. Meteorology.—The highest temperature observed during the five weeks was 70° and the lowest 37°.8. The average temperature was 52°.2, which is about three degrees above the average of corresponding weeks in previous years. There have fallen at Greenwich 4.1 inches of rain, of which more than half fell on Thursday, 22nd October, which is above one-tenth of the average fall of rain during the entire year. 2 WORKHOUSE. Twenty-two deaths have occurred here during the five weeks; one death was from diarrhoea and one from typhoid fever; only 9 cases of diarrhoea have occurred. Influenza has during the last week been very prevalent throughout the house, and is much on the increase. This disease has also been very prevalent throughout the parish.* The weekly average number of inmates has been 1,484. REVIEW OF THE SUMMER QUARTER. During the 13 weeks ending September 26th, 1857, there were registered in the parish of Saint Pancras 965 deaths. During the corresponding quarter of 1856 the number was 983. The average derived from the corresponding quarter in the ten preceding years was 995, which becomes, when raised for increase of population, 1,094. It is thus seen that the mortality of the late quarter has been nearly 12 per cent. below the average of 10 years. These years included, however, the Cholera Summers of 1849 and 1854; but even making allowance for this fact, the late season has been, as measured by the mortality, a more than usually healthy one. As compared with last year, there has been a diminution in the number of deaths from small pox, measles, scarlatina, hooping cough, and low fevers, and an increase in the number from diarrhoea; this is seen in Table I. Meteorology.—The heat of the last quarter has been much above the average. The mean temperature was 63°.6, which is 3½ degrees above the average. Seventy-one days out of 91 were hotter than usual, and the mean temperature of 12 out of the 13 weeks was in excess of its average. The mortality of the entire metropolis during the last quarter was 14,352, which is greater than the mortality of the same period in 1856. So that the metropolis generally has been less healthy than during the Summer of 1856, although Saint Pancras has been more healthy. The increased mortality in London at large has been due to the increased prevalence of diarrhoea, and it has been seen that even in this parish diarrhoea has been fatal to a larger number this year than last; hut the increase has been proportionally less here than in other parts of London. The hottest weeks were the 3rd, 4th, and 9th, weeks of the quarter. The weeks in which the highest mortality from diarrhoea was registered were the 4th, 5th, 6th, and 7th. The largest number of cases of diarrhoea were treated by the District Surgeons from about the 17th to the last day of July. In the Workhouse the greatest number of cases of diarrhoea occurred during the 2nd, 3rd, 4th, and 5th, weeks. As compared with last year, although the mortality from this disease has been higher, yet the number of cases occurring, as far as can be judged from the practice of the District Surgeons, have been fewer, so that the disease, when it has existed, has been of a more fatal character this year than last. The mortality from diarrhoea in the metropolis during the quarter has been 2,343, which would give to Saint Pancras, if this parish had borne its share in proportion to population, 166, whereas in reality the deaths from this disease numbered 125. Sanitary Works.—239 houses have been visited. 104 slaughter-houses and 144 cow-sheds have each been visited several times. 116 notices have been served for the removal of nuisances and the improvement of house property. There have been eight summonses taken out for cases of ordinary nuisances in houses; 7 cow-keepers have been summoned for the filthy state of their premises; two butchers have been summoned and fined for slaughtering in unlicensed places; and large quantities of putrid fish, meat, and rabbits have been seized. I have the honor to remain, Gentlemen, Your obedient Servant, THOMAS HILLIER, MD., L.R.C.P. 21, Upper Gower Street. * This circumstance gives additional confirmation to the fears which I expressed in my Report of last month, that England would within the next twelvemonth be attacked with cholera. For epidemics of influenza have almost invariably preceded epidemics of cholera. [ SCHEDULE A. ] St. Pancras, Middlesex—Table for the Five Weeks ending the 31st day of Oct,, 1857. LOCALITIES. Area in Acres. Population in 1851. Births. Deaths From all causes. From all causes under 5 years of age. From Small Pox. From Measles. From Scarlatina. From Hooping Cough. From Diarrhoea. From Low Fever.  M. F. M.&F. M. F. M.&F. 427 31918 50 46 96 23 27 50 28 1 1 6 2 1 Tottenham Court 27813 52 50 102 17 16 33 13 .. .. 1 4 .. 2 University College Hospital 145 500 5 3 8 Strand Union 120 4 4 8 Gray's Inn Road 155 26462 32 34 66 17 27 44 24 .. 6 2 3 3 2 Royal Free Hospital 60 5 3 8 •• •• •• • • •• •• 1 184 35641 50 70 120 31 30 61 31 2 4 5 3 1 3 Camden Town 171 19515 52 43 95 17 17 34 23 •• •• 2 .. .. .. St. Pancras Workhouse 1600 7 15 22 4 .. .. .. .. 1 1 London Fever Hospital (out of the Parish) 1634 23326 83 66 149 28 22 50 24 .. 2 3 1 4 1 1 2 .. .. .. .. .. .. 2 Totals 319 309 628 155 165 320 147 2 11 11 19 8 16 [ SCHEDULE B. ] Deaths Registered in St. Pancras during Five Weeks ending Oct. 31st, 1857. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. I. Zymotic : Enteritis 1 1 Small pox 2 1 1 Peritonitis 1 .. 1 Measleas 11 11 Ascites Scarlatina 13 12 1 Ulceration of Intestines Hooping cough 19 19 Hernia (Rupture) I .. .. 1 Croup 4 4 Ileus 1 .. .. l Thrush Intussusception 1 .. .. 1 Diarrhoea 6 4 1 1 Stricture of Intestinal Dysentery Canal 3 2 Cholera Disease of Stomach, &c. influnza Disease of Pancreas Scurvy and Purpura Inflammation of Liver (Hepatitis) Ague Jaundice 1 1 Remittent fever Disease of Liver 9 2 1 4 2 Typhus Fever 14 5 7 1 1 Disease of Spleen Puerperal Fever (Metria) 2 .. 2 Rheumatic fever 1 1 VIII. Kidney,&c. Erysispelas 1 .. .. .. 1 Nephritis Syphilis 2 1 1 Nephria (Bright's Dis.) Ischuria 1 .. .. .. 1 Noma(canker) 1 1 Hydrophobia Diabetes Stone II. Dropsy, &c. : Cystitis Haemorrhage 1 .. .. 1 Stricture of Urethra Dropsy 8 1 1 1 5 Disease of Bladder, &c. Abscess 1 .. 1 Ulcer 1 1 IX. Childbirth : Fistula Paramenia mortification 1 .. .. .. .. 1 Ovarian Dropsy Cancer 7 .. 2 3 2 Childbirth (see Metria) Gout Disease of Uterns, &c. 1 .. .. .. .. 1 III. Tubercular; X. Joints, Bones, &c. : Scrofula 1 1 Rheumatism Tabes Mesenterica 2 2 Arthitis Phthisis (Consumption) 39 2 23 12 2 Disease of Joints, &c, 2 1 .. .. 1 Hydrocephalus 4 4 IV. Brain and Nerves : XI. Skin, Cellular Tissue ; cephalitis 4 3 .. .. 1 carbuncle Apoplexy 11 2 .. 3 5 1 Phlegmon palsy(paralysis) 5 1 .. .. 3 1 Disease of Skin, &c. Delirium Tremens 2 .. .. 1 1 chorea XII. Malformations : Epilepsy 2 1 1 Tetanus Cyanosis insanity Spina Convulslion 5 5 Other Malformations 1 .. 1 Disease of Brain, &c. 2 1 •• .. 1 XIII. Premature Birth V. Heart and Blood Vessels ; and Debility 18 18 XIV. Atrophy 11 11 XV. old age 15 .. .. .. 7 8 pericarditis 1 .. .. 1 XVI. Sudden Aneurism 1 .. .. .. 1 Disease of Heart, &c. 4 .. 1 2 1 XVII. Violent Death: VI. Lungs and Organs Intemperence Privation of Food Laryngitis 2 1 .. .. 1 Want of Breast Milk 1 1 bronchitis 29 20 .. 2 7 Cold pleurisy 1 1 poison pneumonia 29 27 1 .. 1 Burns and scalds Asthma 2 .. 1 1 Hanging Disease of lungs Suffocation Drowning VII. Stomach and gestive organ Fractures & Contusions wounds Teething 8 8 Other Violence. Quinsey Causes not Specified 1 1 Gastritis Totals 318 177 48 36 45 12 [ SCHEDULE C. ] St. Pancras, M1ddlesex.—Cases of S1ckness under the care of the D1str1ct Med1cal Off1cers dur1ng the F1ve Weeks end1ng the 31st of October, 1857. Districts. Names of Medical Off1cers. Total No. of Cases. Low Fevers. Diarrhoea. Influenza. Scarlet Fever. Small Pox. Erysipelas. Puerperal Fever. Measles. Hoop1ng Cough. Bronch1t1s, Pleur1sy, and Pneumon1a. Croup. Carbuncles and Bo1ls. Rheumat1sm. Other D1seases. North-West Mr. Adams 118 3 3 .. 3 1 .. .. .. 5 10 .. .. .. 93 South-West Dr. wlldbore 148 3 1 .. 4 .. 1 .. 1 .. 10 .. .. .. 128 South-East Dr. Davis 198 6 15 .. 1 4 .. .. 25 • • 37 .. .. 1 109 Central Mr. SUTHERIN 139 1 11 .. 3 1 2 .. 8 2 16 .. • • 1 94 North Mr. Jefferys 140 2 10 .. 4 .. .. .. 1 1 12 .. .. .. 110 Workhouse & Infirrmary Mr. Coster & Mr. Andrew 234 5 9 •• •• 5 •• 1 26 5 5 178 Totals 977 20 49 .. 15 6 8 •• 35 9 111 .. 5 7 712 TABLE (No. I.) FOR SUMMER QUARTER, 1857. St. Pancras, Middlesex,—Table for the Thirteen Weeks ending 26th day of Sept., 1857. LOCALITIES. Area in Acres. Population in 1851. Births. Deaths From all causes. From all causes under 5 years of age. From Small Pox. From Measles. From Scarlatina From Hooping Cough. From Diarrhoea. | From Low M. F. M.&F. M. F. M.&F. Fever. Regent's Park 427 31918 164 117 281 47 70 117 56 •• •• 5 1 22 1 Tottenham Court 27813 114 87 201 80 71 151 82 .. 2 4 11 27 6 University College Hospital 145 500 29 7 36 4 Strand Union 120 12 12 24 4 .. .. .. .. 1 Gray's Inn Road 155 26462 90 104 194 63 57 120 75 •• 6 •• 2 26 5 Royal Free Hospital 60 9 4 13 .. .. .. .. .. .. 2 Somers Town 184 35641 167 148 315 93 79 172 87 3 9 7 3 21 7 Camden Town 171 19515 100 112 212 39 72 111 61 •• 3 2 5 10 1 St. Pancras Workhouse 1600 43 37 80 10 .. .. .. 1 1 Kentish Town 1634 23326 149 148 297 73 68 141 79 .. .. 5 3 26 10 Hospitals out of the Parish 3 2 5 • • • • •• • • •• • • 2 Totals 784 716 1500 491 479 970 458 3 20 23 26 134 34 Corresponding quarter in 1856 .. .. 729 729 1458 493 490 983 484 5 33 29 32 129 35 TABLE (No. II.) FOR SUMMER QUARTER 1857. Deaths Registered in St. Pancras during the Quarter, ending Sept. 26th, 1857. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 ycars of age and upwards. I. Zymotic : 277 238 14 11 14 Enteritis Small Pox Peritonitis Measles Ascites Scarlatina Ulceration of Intestines Hernia (Rupture) Hooping Cough Croup Ileus Thrush Intussusception Diarrhoea Canal Dysentery Cholera Disease of Stomach, &c. Disease of Pancreas Influenza Scurvy and Purpura Inflammation of Liver (Hepatitis) Ague Remittent Fever Jaundice Infantile Fever Disease of Liver Typhus Fever Disease of Spleen Puerperal Fever (Metria) VIII. Kidney, &c.; 16 .. 4 7 4 1 Rheumatic Fever Erysipelas Nephritis Syphilis Nephria (Bright's Dis.) Noma (Canker) Ischuria Hydrophobia Diabetes [II. Dropsy, &c.: 41 7 7 12 15 Stone Cystitis Haemorrhage Stricture of Urethra Dropsy Disease of Bladder, &c. Abscess Ulcer IX. Childbirth: 11 .. 7 4 Fistula Paramenia Mortification Ovarian Dropsy Cancer Childbirth (see Metria) Gout Disease of Uterns, &c. III. Tubercular; 184 71 67 39 7 X. Joints, Bones, &c.: 7 1 4 1 1 Scrofula Rheumatism Tabes Mesenterica Arthritis Phthisis (Consumption) Disease of Joints, &c Hydrocephalus IV. Brain and Nerves: 100 55 7 13 20 5 XI. Skin, Cellular Tissue; 2 1 .. .. .. 1 Cephalitis Carbuncle Apoplexy Phlegmon Palsy (Paralysis) Disease of Skin, &c. Delirium Tremens XII. Malformations : 3 3 Chorea Epilepsy Tetanus Cyanosis Insanity Spina Bifida Convulsions Other Malformations Disease of Brain, &c XIII. Premature Birth and Debility 32 32 V. Heart and Blood Vessels ; 27 5 4 6 10 2 XIV. Atrophy 50 50 XV. Old Age 51 .. .. 3 24 2 Pericarditis XVI. Sudden Disease of Heart, &c XVII. Violent Death: 48 16 16 10 4 2 VI. Lungs and Organs op Respiration : 60 28 6 10 15 1 Intemperance Privation of food Want of Breast Milk Laryngitis Neglect Bronchitis Cold PLeurisy Poison Pneumonia Burns and scalds Asthma Hanging Disease of Lungs Suffocation VII. Stomach and Digestive Organs; 50 16 10 16 8 Drowning Fractures & Contusions Wounds Teething Other Violence Quinsey Causes not Specified 6 4 1 .. 1 Gastritis Totals 965 526 144 135 123 37 TABLE (No. III.) FOR SUMMER QUARTER, 1857. St. Pancras, Middlesex.—Cases of Sickness under the care of the Parochial Medical Officers during the Thirteen Weeks ending the 26th of September, 1857. Districts. Names of Medical Officers. Total No. of Cases. Low Fevers. Diarrhoea. Influenza. Scarlet Fever. Small Pox. Erysipelas. Puerperal Fever. Measles. Hooping Cough. Bronchitis, Pleurisy, and Pneumonia. Croup. Carbuncles and Boils. Rheumatic Fever. Other Diseases. North-West Mr. Adams 324 6 55 .. 7 .. 3 .. 2 7 7 .. .. 2 235 South-West Dr. WlLDBORE 480 15 113 .. 7 • • 2 .. 19 6 12 .. 4 302 South-East Dr. Davis 495 5 152 .. 4 19 2 .. 13 3 6 • • 3 1 287 Central Mr. Sutherin 378 16 56 .. 1 7 • • .. 16 5 18 .. .. 1 258 North Mr. Jefferys 359 7 85 .. 4 3 3 .. 3 2 4 .. .. 3 245 Workhouse & Infirmary Mr. Coster & Mr. Andrew 576 3 153 .. •• 1 3 .. •• 4 31 .. 4 6 371 The entire Parish 2612 52 614 •• 23 30 13 .. 53 27 78 7 17 1698 REPORT on the SANITARY CONDITION OF SAINT PANCRAS, MIDDLESEX, DURING NOVEMBER, 1857, by THOMAS HILLIER, M.D., Medical Officer of Health for the Parish of Saint Pancras. December 8th, 1857.] [No. 20. TO THE SANITARY COMMITTEE. Gentlemen, The number of deaths registered during the four weeks of November amounted to 333, giving an average weekly mortality of 83.25. Last month the weekly average was only 63.6. In the corresponding weeks of the ten immediately preceding years, the average mortality was 296.5, which gives, when a correction is made for the increase of population, 326; so that, although the present return exhibits a very great increase of mortality since last month, yet it is not very much above the corrected average of previous years. Zymotic diseases have been fatal to 66 persons. Measles, Scarlatina, Typhus, and Hooping Cough have been fatal to about the same degree as in October. There have been no deaths from Small Pox. There have been six deaths from Diarrhoea. Tubercular diseases have been fatal in 39 cases. The increase in mortality observed this month has been in a great measure due to the deaths from diseases of the lungs and respiratory organs. There have been 88 deaths from such diseases in four weeks, instead of 63 in five weeks, that is to say, a weekly mortality of 22 instead of 12.5 There has also been an increase in the mortality from old age, 28 having died instead of 15. These facts are to a great extent explicable by the change in the weather. Meteorology.—The highest temperature was on the 3rd 46°.3, and the lowest on the 10th 30o.0. The average temperature was 46°.2, which is 2°.8 above the average of the season. The wind with few exceptions has been North or East, or between the two; and the atmosphere has been exceedingly damp. It is the combination of dampness with cold that has probably caused so many pulmonary affections. Only one death has been registered under the head of Influenza, but there is reason to believe that some of those given under Bronchitis might fairly have been ascribed to Influenza. There is no doubt that the disease has been and is very prevalent; but there is frequently much difficulty in determining whether a case is merely a severe Catarrh and Bronchitis, or real Influenza; and some Medical men scarcely ever use the latter term. From what I have been able to learn, there has not been so much debility during the attacks this season as is usually observed with this disease. Amongst children under five years there have been 133 deaths, a rather smaller proportion than usual; above the age of 60, there have been 99 deaths, which is considerably above the average. Scarlet Fever of a very virulent description has occurred in and near George Street, Hampstead Road. In two families living in two houses, there were within a fortnight seven deaths from this disease. These cases are only two of them registered on the accompanying tables; they will be given on the weekly register supplied to me this week. I have visited the houses in which these deaths occurred, and although their sanitary state admits of improvement, I cannot ascribe the fatality of the disease 2 entirely to this circumstance. The disease appears to have been propagated by infection or contagion from one patient to another. I am not prepared to say what occasioned the extreme virulence of the earliest case. The occurrenoe illustrates the immense importance of removing the healthy from the sick when such diseases as Scarlet Fever arise in a family. It is better to send away the healthy from the sick than the sick from the healthy, wherever this is practicable; but if from the circumstances of the family this is impossible, the patient may be removed to the Fever Hospital, either by paying a guinea, or in case of poverty at the expense of the Parish. "WORKHOUSE. The mortality has amounted to 18, which is a low number, especially for this season of the year. Of this number 13 were of persons above the age of 10. In the workhouse there have been 126 cases of Influenza under treatment, besides 46 cases of Bronchitis, Pleurisy, or Pneumonia. There have been under the care of all the Parochial Medical Officers no fewer than 372 cases of Bronchitis, Pneumonia, Pleurisy, and Influenza. The building is now very full; the average number during the month has been 1,571. The average number in the sick wards has been 314, in the separation wards 116, and in the lunatic wards 118. Diarrhoea Returns.—At the beginning of the summer a series of questions relating to Diarrhoea were drawn up, and copies of them placed in the hands of each District Medical Officer, in order to obtain some definite information as to the external conditions under which the cases of that disease which came under their treatment occurred, and to get some clue to the most frequent determining causes of Diarrhoea amongst the poor. The questions referred to the sex, age, occupation, and residence, of the patient, also to the room he occupied, his habits in respect to alcoholic drink, the drainage of the house, the state of crowding, the usual diet of the patient, and that which immediately preceded the attack. There were also questions relating to the amount of water drunk immediately before the attack, and the quantity of water usually drunk by the patient. Answers have been obtained to these questions in 374 oases, so far as it was possible to give the required information; and subjoined is a summary of some of the more interesting results obtained from a careful analysis of them. Of the whole number 150 were under five years of age, and 50 above 60 years. Of all those above 12, there were 144 females and only 63 males. This fact is a very interesting one, showing that amongst adult females who spend much time in the house, there was more than twice as much Diarrhoea as amongst adult males who are much more engaged in the open air. It is young children and women who are most exposed to the continued effects of bad drainage, overcrowded and ill-ventilated rooms. Amongst children the number of each sex was as might be expected nearly equal. Forty-two of the patients lived in underground rooms, 81 lived in houses known to be very badly drained. Fifty in rooms much overcrowded, and fifty others in rooms rather crowded. Nine were known to be habitual drunkards, and many more drank very freely. Twenty-two are known to have taken foul water just before the attack; and 39 drank just before their illness more water than they usually took. In 21 cases the Diarrhoea could be traced to errors in diet. Twenty-two appeared to depend in part on extreme poverty of diet. These facts are very interesting, confirming as they do the oft repeated observation that very many of the prevalent diseases depend on causes which admit readily of removal. I have the honour to remain, Gentlemen, Your obedient Servant, 21, upper Gower Street. THOMAS HILLIER, M.D., L.R.C.P. [SCHEDULE A.] St. Pancras, Middlesex—Table for the Four Weeks ending 28th day of Nov., 1857. LOCALITIES. Area in Aores. Population in 1851. Births. Deaths From all causes. From all causes under 5 years of age. | From Small Pox. From Measles. | From Scarlatina. |From Hooping Cough. I From Diarrhoea. | From Low Fever. M. F. M.&F. M. F. M.&F. Regent's Park 427 31918 50 38 88 37 20 57 23 .. .. 2 2 2 3 Tottenham Court 27813 44 28 72 26 17 43 21 .. .. 1 7 1 1 University College Hospital 145 500 6 7 13 Strand Union 120 6 8 14 1 Gray's Inn Road 155 26462 40 31 71 13 20 33 13 .. 2 •• 5 •• 1 Royal Free Hospital 60 5 3 8 Somers Town 184 35641 55 51 106 24 42 66 34 .. 5 5 1 4 4 Camden Town 171 19515 35 33 68 9 18 27 14 •• •• 2 2 .. 1 St. Pancras Workhouse 1600 4 14 18 1 Kentish Town 1634 23326 55 38 93 23 31 54 26 .. 2 1 2 1 Hospitals out of the Parish 1 .. 1 Totals 279 219 498 154 180 334 133 •• 9 11 19 8 10 [ SCHEDULE B. ] Deaths Registered in St. Pancras during the Four Weeks ending Nov. 28th, 1857. Causes of Death. At all Ages. Under 20 years of age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. Causes of Death. At all Ages. Under 20 years ot age. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. At 80 years of age and upwards. I. Zymotic : Enteritis Small Pox Peritonitis Measles 8 8 Ascites Scarlatina 11 10 1 Ulceration of Intestines Hooping Cough 18 18 Hernia (Rupture) 1 .. .. .. 1 Croup 3 3 Ileus 3 2 •• 1 Thrush 1 1 Intussusception Diarrhoea 6 5 .. .. .. 1 Stricture of Intestinal Canal 1 .. .. .. 1 Dysentery 1 1 Cholera Disease of stomach, &c. 1 .. .. .. 1 Influenza 1 .. .. .. 1 Disease of pancreas Scurvy and Purpura (Hepatitis) Ague Remittent Fever Jaundice 1 1 Infantile Fever Disease of Liver 4 .. 1 2 1 Typhus Fever 12 6 2 2 .. 2 Disease of spleen Puerperal Fever (Metria) VIII. Kidney, &c.: Rheumatic Fever 1 .. 1 Erysipelas 4 .. 2 1 .. 1 Nephritis 1 .. .. .. 1 Syphilis Nephria (Bright's Dis.) 8 .. I 6 .. 1 Noma (Canker) Ischuria Hydrophobia Diabetes 1 .. 1 Stone II. Dropsy, &c. : Cystitis Haemorrhage Stricture of Urethra Disease of Bladder, &c. Dropsy 3 .. .. 1 2 Abscess 8 1 1 1 IX. Childbirth: Ulcer 1 .. .. .. 1 Fistula Paramenia Mortification 4 1 .. .. 1 2 Ovarian Dropsy Cancer 11 .. 3 3 5 Childbirth (see Metria) Gout Disease of Uterns, &c. 1 .. 1 III. Tubercular: X. Joints, Bones, &c.: Scrofula 1 1 Rheumatism Tabes Mesenterica 4 4 Arthritis Phthisis (Consumption) 32 7 11 13 1 Disease of Joints, &c. Hydrocephalus 2 2 IV. Brain and Nerves : XI. Skin, Cellular Tissue : Cephalitis 6 5 .. .. 1 Carbuncle Apoplexy 10 .. .. .. 9 1 Phlegmon Palsy (Paralysis) 3 .. .. .. 3 Disease of Skin, &c. Delirium Tremens 1 .. .. 1 Chorea XII. Malformation: Epilepsy Tetanus Cyanosis Insanity Spina Bifida Convulsions 8 8 Other Malformations Disease of Brain, &c 2 •• • • 2 XIII. Premature Birth 8 8 V. Heart and blood Vessels : XIV. Atrophy 3 3 XV. Old Age 28 .. .. .. 15 13 Pericarditis 1 .. 1 XVI. Sudden Aneurism Disease of Heart, &c 10 1 .. 3 6 XVII. Violent Death: VI. Lungs and Organs of Respiration : Intemperance 1 .. .. 1 Privation of Food Want of Breast Milk 3 3 Laryngitis Neglect Bronchitis 52 16 5 7 21 3 Cold Pleurisy Poison 2 1 .. 1 Pneumonia 29 23 1 3 1 1 Burns and Scalds 1 1 Asthma 1 .. .. .. 1 Hanging Disease of Lungs 6 3 .. 2 1 Suffocation 2 1 .. .. 1 Drowning VII. Stomach and Digestive Organs: Fractures & Contusions Wounds 2 1 .. 1 Teething 2 2 Other Violence Causes not Specified 3 3 Quinsey 1 1 Gastritis Totals 333 151 32 51 74 25 [SCHEDULE C.] St. Pancras, Middlesex.—Cases of Sickness under the care of the Parochial Medical Officers during the Four Weeks ending the 28th of November, 1857. Districts. Names of Medical Officers. Total No. of Cases. Low Fevers. Diarrhoea. Influenza. Scarlet Fever. Small Pox. Erysipelas. Puerperal Fever. Measles. Hooping Cough. Bronchitis, Pleurisy, and Pneumonia. Croup. Carbuncles. Rheumatic Fever. Other Diseases. North-West Mr. Adams 143 4 2 2 3 2 1 .. 2 8 11 .. .. .. 108 South-West Dr. wildbore 180 1 .. 3 2 • • •• .. 1 5 43 •• .. •• 125 South-East Dr. Davis 218 .. 13 .. 3 1 •• 8 •• 71 .. 1 120 Central Mr. Sutherin 149 .. 6 6 .. 1 2 5 5 33 •• .. 1 90 North Mr. Jefferys 146 2 2 25 4 .. .. .. 3 6 .. .. .. 104 Workhouse & Infirmary Mr. Coster & Dr. Andrew 265 1 2 126 •• •• •• 1 •• 46 •• 1 3 85 Totals 1101 8 25 162 12 4 3 .. 17 21 210 1 1 5 632